- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.23 / $31.74 / $6,800.33
| Facility | | $30.23 | $31.74 | $6,800.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $64.08
| Professional | | $30.23 | $30.23 | $64.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $76.91
| Professional | | $30.23 | $30.23 | $76.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $31.96
| Facility | | $30.44 | $30.44 | $31.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $30.44
| Professional | | $30.44 | $30.44 | $30.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.52 / $30.23 / $85.00
| Facility | | $28.52 | $30.23 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $42.78
| Professional | | $30.23 | $30.23 | $42.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.23 / $42.78 / $332.00
| Facility | | $30.23 | $42.78 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.37 / $32.79 / $37.82
| Professional | | $31.37 | $32.79 | $37.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $31.37
| Facility | | $30.23 | $30.23 | $31.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $31.37 / $31.37
| Professional | | $30.23 | $31.37 | $31.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.36 / $121.36 / $121.36
| Facility | | $121.36 | $121.36 | $121.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.52 / $32.32 / $597.00
| Facility | | $28.52 | $32.32 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $54.81
| Professional | | $30.23 | $30.23 | $54.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $30.23 / $47.18
| Professional | | $30.23 | $30.23 | $47.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.37 / $31.37 / $33.15
| Facility | | $31.37 | $31.37 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $31.37 / $31.37
| Professional | | $30.23 | $31.37 | $31.37 |