- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.91 / $28.91 / $44.81
| Facility | | $28.91 | $28.91 | $44.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.94 / $30.00 / $30.72
| Professional | | $24.94 | $30.00 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.71
| Professional | | $30.00 | $30.00 | $30.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $33.00
| Facility | | $30.00 | $30.00 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.72 / $32.59 / $85.00
| Facility | | $30.72 | $32.59 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $30.72
| Professional | | $30.72 | $30.72 | $30.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $62.98
| Facility | | $30.72 | $30.72 | $62.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $30.72
| Professional | | $30.72 | $30.72 | $30.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.72 / $31.80 / $31.80
| Facility | | $30.72 | $31.80 | $31.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $31.80
| Professional | | $30.72 | $30.72 | $31.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.64 / $85.00 / $555.00
| Facility | | $31.64 | $85.00 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $30.72 / $30.72
| Professional | | $8.00 | $30.72 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $31.71 / $40.20
| Professional | | $30.00 | $31.71 | $40.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $30.72
| Facility | | $30.72 | $30.72 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $31.80
| Professional | | $30.72 | $30.72 | $31.80 |