- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.42 / $65.42 / $66.00
| Facility | | $65.42 | $65.42 | $66.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $14.68 / $17.91
| Professional | | $11.92 | $14.68 | $17.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $14.41 / $27.02
| Professional | | $14.07 | $14.41 | $27.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $17.18 / $21.37
| Professional | | $14.06 | $17.18 | $21.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.27 / $15.85 / $30.40
| Professional | | $15.27 | $15.85 | $30.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.17 / $23.17 / $23.17
| Facility | | $23.17 | $23.17 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $16.72 / $25.87
| Professional | | $11.17 | $16.72 | $25.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.80 / $22.95 / $22.95
| Professional | | $17.80 | $22.95 | $22.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.54 / $18.62 / $18.75
| Professional | | $17.54 | $18.62 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.06 / $17.18 / $20.95
| Professional | | $14.06 | $17.18 | $20.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.42 / $65.42 / $66.00
| Facility | | $65.42 | $65.42 | $66.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.75 / $15.41 / $21.85
| Professional | | $12.75 | $15.41 | $21.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $17.39 / $23.98
| Professional | | $17.39 | $17.39 | $23.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.17 / $23.17 / $23.17
| Facility | | $23.17 | $23.17 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $16.57 / $26.99
| Professional | | $11.05 | $16.57 | $26.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $15.12 / $17.39
| Professional | | $14.12 | $15.12 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $15.90 / $25.91
| Professional | | $11.77 | $15.90 | $25.91 |