- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.38 / $38.90
| Professional | | $10.72 | $17.38 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $47.86 / $69.18
| Facility | | $38.02 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $1.51
| Facility | | $0.56 | $0.56 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $20.42 / $25.12
| Professional | | $14.79 | $20.42 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $40.74
| Professional | | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $21.88
| Professional | | $5.01 | $5.01 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Facility | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $17.38 / $38.90
| Professional | | $11.48 | $17.38 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $18.20 / $23.99
| Facility | | $12.02 | $18.20 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $17.38 / $38.90
| Professional | | $5.01 | $17.38 | $38.90 |