- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.36 / $33.38 / $60.74
| Facility | | $27.36 | $33.38 | $60.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $36.94
| Professional | | $30.17 | $30.17 | $36.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $50.39
| Professional | | $30.17 | $30.17 | $50.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.24 / $42.24 / $44.35
| Facility | | $42.24 | $42.24 | $44.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.24 / $42.24 / $42.24
| Professional | | $42.24 | $42.24 | $42.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.46 / $28.46 / $48.28
| Facility | | $28.46 | $28.46 | $48.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $30.17
| Professional | | $30.17 | $30.17 | $30.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.46 / $52.08 / $332.00
| Facility | | $28.46 | $52.08 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.72 / $32.72 / $58.74
| Professional | | $32.72 | $32.72 | $58.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $31.30
| Facility | | $30.17 | $30.17 | $31.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $31.30
| Professional | | $30.17 | $30.17 | $31.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.46 / $28.46 / $555.00
| Facility | | $28.46 | $28.46 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $30.17 / $45.57
| Professional | | $5.00 | $30.17 | $45.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $46.88
| Professional | | $30.17 | $30.17 | $46.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.30 / $31.30 / $31.30
| Facility | | $31.30 | $31.30 | $31.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.46 / $30.17 / $31.30
| Professional | | $3.46 | $30.17 | $31.30 |