- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.39 / $24.10 / $51.04
| Facility | | $23.39 | $24.10 | $51.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.18 / $23.39 / $26.48
| Professional | | $21.18 | $23.39 | $26.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $22.85 / $22.85
| Professional | | $22.85 | $22.85 | $22.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.39 / $23.39 / $80.00
| Facility | | $23.39 | $23.39 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.51 / $22.51 / $33.92
| Facility | | $22.51 | $22.51 | $33.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.51 / $22.51 / $22.51
| Professional | | $22.51 | $22.51 | $22.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $116.95 / $116.95
| Facility | | $75.00 | $116.95 | $116.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.62 / $100.62 / $119.16
| Professional | | $100.62 | $100.62 | $119.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.45 / $23.39 / $44.72
| Facility | | $21.45 | $23.39 | $44.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.86 / $23.39 / $23.39
| Professional | | $19.86 | $23.39 | $23.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.39 / $28.07 / $52.60
| Professional | | $23.39 | $28.07 | $52.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.98 / $23.39 / $39.93
| Facility | | $21.98 | $23.39 | $39.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.51 / $22.51 / $27.59
| Professional | | $22.51 | $22.51 | $27.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $23.39 / $24.57
| Professional | | $22.07 | $23.39 | $24.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $22.07 / $30.90
| Professional | | $22.07 | $22.07 | $30.90 |