- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $12.62
| Facility | | $12.49 | $12.49 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $12.99
| Professional | | $12.49 | $12.49 | $12.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.54 / $4.05 / $7.78
| Facility | | $1.54 | $4.05 | $7.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $121.37 / $121.37
| Facility | | $80.00 | $121.37 | $121.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.78 / $12.49 / $12.49
| Facility | | $11.78 | $12.49 | $12.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $12.49
| Professional | | $12.49 | $12.49 | $12.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,184.50 / $6,184.50 / $6,184.50
| Professional | | $6,184.50 | $6,184.50 | $6,184.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.62 / $12.38 / $22.50
| Facility | | $4.62 | $12.38 | $22.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $15.61
| Professional | | $12.49 | $12.49 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $14.90 / $205.54
| Professional | | $12.90 | $14.90 | $205.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.62 / $12.49 / $21.86
| Facility | | $4.62 | $12.49 | $21.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $15.13
| Professional | | $12.49 | $12.49 | $15.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $12.49 / $12.65
| Professional | | $12.49 | $12.49 | $12.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $12.49 / $16.86
| Professional | | $12.38 | $12.49 | $16.86 |