- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $30.44
| Facility | | $30.44 | $30.44 | $30.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $30.44 / $37.14
| Professional | | $30.44 | $30.44 | $37.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.44 / $76.22 / $757.05
| Facility | | $30.44 | $76.22 | $757.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $34.74 / $38.51
| Professional | | $30.44 | $34.74 | $38.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.50 / $43.41 / $92.53
| Facility | | $36.50 | $43.41 | $92.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.42 / $33.42 / $33.42
| Facility | | $33.42 | $33.42 | $33.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $33.42 / $33.42
| Professional | | $33.42 | $33.42 | $33.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.97 / $37.61 / $75.23
| Professional | | $31.97 | $37.61 | $75.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $34.65 / $73.48
| Professional | | $29.46 | $34.65 | $73.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.80 / $114.80 / $114.80
| Facility | | $114.80 | $114.80 | $114.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.37 / $56.37 / $757.05
| Facility | | $56.37 | $56.37 | $757.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.74 / $35.81 / $46.11
| Professional | | $30.74 | $35.81 | $46.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.74 / $35.81 / $46.38
| Professional | | $30.74 | $35.81 | $46.38 |