- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.35 / $31.35 / $31.35
| Facility | | $31.35 | $31.35 | $31.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $31.35 / $39.19
| Professional | | $31.35 | $31.35 | $39.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $84.61 / $357.50
| Professional | | $32.65 | $84.61 | $357.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.31 / $113.66 / $179.31
| Facility | | $33.31 | $113.66 | $179.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.31 / $62.12 / $70.59
| Professional | | $33.31 | $62.12 | $70.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.35 / $35.14 / $77.23
| Facility | | $31.35 | $35.14 | $77.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.35 / $35.14 / $78.30
| Facility | | $31.35 | $35.14 | $78.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $32.65 / $68.59
| Professional | | $32.65 | $32.65 | $68.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.81 / $65.00 / $255.73
| Professional | | $32.81 | $65.00 | $255.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.35 / $35.14 / $77.23
| Facility | | $31.35 | $35.14 | $77.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.31 / $102.58 / $151.03
| Professional | | $1.31 | $102.58 | $151.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.18 / $216.18 / $216.18
| Facility | | $216.18 | $216.18 | $216.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.31 / $155.46 / $354.51
| Professional | | $33.31 | $155.46 | $354.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.53 / $45.53 / $45.53
| Professional | | $45.53 | $45.53 | $45.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.23 / $146.58 / $146.58
| Professional | | $54.23 | $146.58 | $146.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $32.65 / $42.46
| Professional | | $32.65 | $32.65 | $42.46 |