- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.09 / $75.09 / $75.09
| Facility | | $75.09 | $75.09 | $75.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $30.20 / $76.22
| Professional | | $17.70 | $30.20 | $76.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.40 / $126.40 / $126.40
| Facility | | $126.40 | $126.40 | $126.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.83 / $39.92 / $3,255.68
| Professional | | $22.83 | $39.92 | $3,255.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.16 / $65.16 / $65.16
| Facility | | $65.16 | $65.16 | $65.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.01 / $25.01 / $33.89
| Professional | | $25.01 | $25.01 | $33.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $32.04 / $62.82
| Professional | | $16.05 | $32.04 | $62.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.27 / $38.27 / $45.02
| Professional | | $38.27 | $38.27 | $45.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.61 / $50.29 / $67.83
| Professional | | $26.61 | $50.29 | $67.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.99 / $26.99 / $29.27
| Professional | | $26.99 | $26.99 | $29.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.40 / $126.40 / $126.40
| Facility | | $126.40 | $126.40 | $126.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.21 / $37.01 / $3,255.68
| Professional | | $22.21 | $37.01 | $3,255.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.47 / $28.42 / $67.54
| Facility | | $23.47 | $28.42 | $67.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $32.77 / $39.92
| Professional | | $25.82 | $32.77 | $39.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.71 / $32.88 / $84.86
| Professional | | $21.71 | $32.88 | $84.86 |