- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $31.75 / $44.82
| Professional | | $20.02 | $31.75 | $44.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.86 / $23.37 / $30.77
| Professional | | $19.86 | $23.37 | $30.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.94 / $32.94 / $36.22
| Professional | | $32.94 | $32.94 | $36.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.79 / $39.79 / $39.79
| Facility | | $39.79 | $39.79 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.82 / $166.82 / $166.82
| Professional | | $166.82 | $166.82 | $166.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.56 / $36.96 / $47.29
| Professional | | $30.56 | $36.96 | $47.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.02 / $31.75 / $44.82
| Facility | | $20.02 | $31.75 | $44.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.35 / $49.00 / $79.92
| Professional | | $44.35 | $49.00 | $79.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.98 / $37.22 / $55.76
| Facility | | $25.98 | $37.22 | $55.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.98 / $37.22 / $55.76
| Professional | | $25.98 | $37.22 | $55.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.62 / $21.45 / $37.67
| Professional | | $16.62 | $21.45 | $37.67 |