- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $75.86 / $199.53
| Facility | | $51.29 | $75.86 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $60.26 / $125.89
| Professional | | $51.29 | $60.26 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $79.43 / $177.83
| Facility | | $51.29 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $51.29 / $147.91
| Professional | | $38.90 | $51.29 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $64.57 / $93.33
| Facility | | $51.29 | $64.57 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $87.10 / $117.49
| Professional | | $66.07 | $87.10 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $52.48 / $100.00
| Professional | | $30.90 | $52.48 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.48 / $102.33 / $7,079.46
| Facility | | $52.48 | $102.33 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $72.44 / $107.15
| Professional | | $56.23 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $109.65
| Professional | | $51.29 | $51.29 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $81.28 / $165.96
| Facility | | $51.29 | $81.28 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $79.43 / $177.83
| Facility | | $51.29 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $151.36
| Professional | | $43.65 | $51.29 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $56.23 / $100.00
| Facility | | $51.29 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $72.44 / $89.13
| Professional | | $51.29 | $72.44 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $51.29 / $61.66
| Facility | | $30.90 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $51.29 / $93.33
| Professional | | $30.90 | $51.29 | $93.33 |