- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $67.76
| Facility | | $33.88 | $33.88 | $67.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $34.21 / $2,165.40
| Professional | | $33.88 | $34.21 | $2,165.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.09 / $90.80 / $169.40
| Facility | | $37.09 | $90.80 | $169.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $155.61
| Professional | | $33.88 | $33.88 | $155.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.32 / $41.60 / $76.40
| Facility | | $36.32 | $41.60 | $76.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $55.73 / $60.81
| Professional | | $33.88 | $55.73 | $60.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.17 / $68.95 / $8,090.00
| Facility | | $35.17 | $68.95 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.80 / $4,065.60 / $4,166.39
| Professional | | $2,032.80 | $4,065.60 | $4,166.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $169.40 / $169.40
| Facility | | $75.00 | $169.40 | $169.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $155.61
| Professional | | $33.88 | $33.88 | $155.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.44 / $42.51 / $59.18
| Professional | | $35.44 | $42.51 | $59.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $50.82
| Professional | | $33.88 | $33.88 | $50.82 |