- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $39.53 / $71.28
| Facility | | $32.15 | $39.53 | $71.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $37.58
| Professional | | $32.15 | $32.15 | $37.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.72 / $25.72 / $32.15
| Facility | | $25.72 | $25.72 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.81 / $32.15 / $32.15
| Professional | | $31.81 | $32.15 | $32.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.33 / $30.33 / $32.38
| Facility | | $30.33 | $30.33 | $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
- Facility
- Modifier
- Low / Median / High Price
- $31.33 / $47.00 / $332.00
| Facility | | $31.33 | $47.00 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.33 / $31.33 / $39.22
| Professional | | $31.33 | $31.33 | $39.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $32.75
| Facility | | $32.15 | $32.15 | $32.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.75 / $32.75
| Professional | | $32.15 | $32.75 | $32.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.33 / $32.15 / $555.00
| Facility | | $30.33 | $32.15 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $37.14
| Professional | | $32.15 | $32.15 | $37.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.15 / $43.40
| Professional | | $32.15 | $32.15 | $43.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.75 / $32.75 / $32.75
| Facility | | $32.75 | $32.75 | $32.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $32.75 / $32.75
| Professional | | $32.15 | $32.75 | $32.75 |