- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.59 / $74.59 / $80.38
| Facility | | $74.59 | $74.59 | $80.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $33.43 / $39.20
| Professional | | $32.14 | $33.43 | $39.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.59 / $35.74 / $101.88
| Facility | | $28.59 | $35.74 | $101.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $33.36
| Professional | | $32.15 | $32.15 | $33.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.38
| Facility | | $32.15 | $32.15 | $32.38 |
- 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 / $32.15
| Professional | | $32.15 | $32.15 | $32.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.59 / $74.59 / $80.38
| Facility | | $74.59 | $74.59 | $80.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $33.43 / $54.43
| Professional | | $32.14 | $33.43 | $54.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $46.62
| Professional | | $32.15 | $32.15 | $46.62 |