- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.50 / $30.55 / $209.96
| Facility | | $23.50 | $30.55 | $209.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $25.20 / $30.55
| Professional | | $25.20 | $25.20 | $30.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $25.20 / $56.98
| Professional | | $25.20 | $25.20 | $56.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.49 / $26.49 / $27.81
| Facility | | $26.49 | $26.49 | $27.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.49 / $26.49 / $26.49
| Professional | | $26.49 | $26.49 | $26.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.78 / $26.97 / $85.00
| Facility | | $23.78 | $26.97 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $25.20 / $35.67
| Professional | | $25.20 | $25.20 | $35.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.34 / $39.24 / $332.00
| Facility | | $27.34 | $39.24 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.16 / $27.34 / $35.71
| Professional | | $26.16 | $27.34 | $35.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.20 / $25.20 / $26.16
| Facility | | $25.20 | $25.20 | $26.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $26.16 / $26.16
| Professional | | $25.20 | $26.16 | $26.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.47 / $37.47 / $37.47
| Facility | | $37.47 | $37.47 | $37.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.78 / $27.77 / $85.00
| Facility | | $23.78 | $27.77 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $25.20 / $118.00
| Professional | | $25.20 | $25.20 | $118.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $26.64 / $38.56
| Professional | | $25.20 | $26.64 | $38.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.16 / $26.16 / $26.16
| Facility | | $26.16 | $26.16 | $26.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $26.16 / $26.16
| Professional | | $25.20 | $26.16 | $26.16 |