- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $29.91
| Facility | | $29.91 | $29.91 | $29.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $31.21
| Professional | | $29.91 | $29.91 | $31.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.41 / $89.28 / $135.06
| Facility | | $31.41 | $89.28 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $135.06
| Professional | | $29.91 | $29.91 | $135.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.09 / $36.72 / $67.45
| Facility | | $32.09 | $36.72 | $67.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $29.91
| Facility | | $29.91 | $29.91 | $29.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $29.91
| Professional | | $29.91 | $29.91 | $29.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.51 / $53.00 / $8,090.00
| Facility | | $30.51 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $35.47 / $41.73
| Professional | | $35.47 | $35.47 | $41.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $29.91
| Professional | | $29.91 | $29.91 | $29.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,684.67 / $12,684.67 / $13,261.25
| Facility | | $12,684.67 | $12,684.67 | $13,261.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $135.06
| Facility | | $75.00 | $75.00 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.91 / $29.91 / $135.06
| Professional | | $29.91 | $29.91 | $135.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.52 / $29.91 / $56.40
| Professional | | $27.52 | $29.91 | $56.40 |