- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $4.38 / $5.56
| Facility | | $4.38 | $4.38 | $5.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.38 / $4.38
| Professional | | $4.12 | $4.38 | $4.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.00 / $967.00 / $967.00
| Facility | | $967.00 | $967.00 | $967.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.79 / $26.79 / $26.79
| Professional | | $26.79 | $26.79 | $26.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $28.50 / $28.50
| Facility | | $28.50 | $28.50 | $28.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $13.56 / $13.56
| Professional | | $13.56 | $13.56 | $13.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.85 / $32.04 / $35.09
| Professional | | $24.85 | $32.04 | $35.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $4.38 / $5.56
| Facility | | $4.38 | $4.38 | $5.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.38 / $4.38
| Professional | | $4.12 | $4.38 | $4.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.40 / $52.80 / $52.80
| Professional | | $43.40 | $52.80 | $52.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $28.50 / $28.50
| Facility | | $28.50 | $28.50 | $28.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $13.56 / $13.56
| Professional | | $13.56 | $13.56 | $13.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.50 / $25.50 / $25.81
| Facility | | $25.50 | $25.50 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.53 / $25.50 / $25.81
| Professional | | $22.53 | $25.50 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.96 / $14.22 / $25.39
| Professional | | $11.96 | $14.22 | $25.39 |