- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $64.30
| Facility | | $32.15 | $32.15 | $64.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $35.36
| Professional | | $32.15 | $32.15 | $35.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.81 / $86.16 / $160.75
| Facility | | $31.81 | $86.16 | $160.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $143.25
| Professional | | $32.15 | $32.15 | $143.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.46 / $39.47 / $76.70
| Facility | | $34.46 | $39.47 | $76.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Facility | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.04 / $64.80 / $8,090.00
| Facility | | $33.04 | $64.80 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $37.21
| Professional | | $32.15 | $32.15 | $37.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,186.60 / $21,186.60 / $24,855.09
| Facility | | $21,186.60 | $21,186.60 | $24,855.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $160.75 / $160.75
| Facility | | $75.00 | $160.75 | $160.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $143.25
| Professional | | $32.15 | $32.15 | $143.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.67 / $36.67 / $36.67
| Facility | | $36.67 | $36.67 | $36.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $40.40
| Professional | | $32.15 | $32.15 | $40.40 |