- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.47 / $36.47 / $56.54
| Facility | | $36.47 | $36.47 | $56.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.46 / $37.85 / $38.76
| Professional | | $31.46 | $37.85 | $38.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.61 / $38.00 / $40.28
| Professional | | $37.61 | $38.00 | $40.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.08 / $25.08 / $26.33
| Facility | | $25.08 | $25.08 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.08 / $25.08 / $25.08
| Professional | | $25.08 | $25.08 | $25.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.93 / $38.76 / $38.76
| Facility | | $34.93 | $38.76 | $38.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $38.76
| Professional | | $38.76 | $38.76 | $38.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $58.14 / $332.00
| Facility | | $38.76 | $58.14 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $49.14
| Professional | | $38.76 | $38.76 | $49.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $40.28 / $40.28
| Facility | | $38.76 | $40.28 | $40.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $40.28
| Professional | | $38.76 | $38.76 | $40.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.97 / $38.76 / $555.00
| Facility | | $35.97 | $38.76 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $38.76
| Professional | | $38.76 | $38.76 | $38.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $40.19 / $50.92
| Professional | | $38.00 | $40.19 | $50.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $38.76
| Facility | | $38.76 | $38.76 | $38.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $38.76 / $40.28
| Professional | | $38.76 | $38.76 | $40.28 |