- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $30.44
| Facility | | $30.44 | $30.44 | $30.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $33.47
| Professional | | $30.44 | $30.44 | $33.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.35 / $29.84 / $37.86
| Professional | | $29.35 | $29.84 | $37.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.95 / $28.95 / $28.95
| Facility | | $28.95 | $28.95 | $28.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.95 / $28.95 / $28.95
| Professional | | $28.95 | $28.95 | $28.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.39 / $34.39 / $34.39
| Facility | | $33.39 | $34.39 | $34.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $33.42 / $33.42
| Professional | | $33.42 | $33.42 | $33.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $45.66 / $332.00
| Facility | | $30.44 | $45.66 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $59.84
| Professional | | $30.44 | $30.44 | $59.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.84 / $29.84 / $30.44
| Facility | | $29.84 | $29.84 | $30.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.84 / $29.84 / $30.44
| Professional | | $29.84 | $29.84 | $30.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.42 / $34.39 / $597.00
| Facility | | $33.42 | $34.39 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $35.00 / $35.00
| Professional | | $33.42 | $35.00 | $35.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.74 / $35.81 / $47.17
| Professional | | $30.74 | $35.81 | $47.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.93 / $30.44 / $30.44
| Facility | | $15.93 | $30.44 | $30.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.93 / $26.57 / $30.44
| Professional | | $15.93 | $26.57 | $30.44 |