- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.00 / $49.10 / $74.40
| Facility | | $20.00 | $49.10 | $74.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $29.25 / $52.00
| Professional | | $20.00 | $29.25 | $52.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.35 / $53.89 / $90.00
| Facility | | $22.35 | $53.89 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $23.53 / $27.50
| Professional | | $22.35 | $23.53 | $27.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.25 / $30.02 / $64.00
| Facility | | $25.25 | $30.02 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.53 / $23.53 / $23.53
| Professional | | $23.53 | $23.53 | $23.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.10 / $22.10 / $22.10
| Facility | | $22.10 | $22.10 | $22.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $22.10 / $22.10
| Professional | | $22.10 | $22.10 | $22.10 |
- 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
- $19.00 / $22.35 / $46.42
| Professional | | $19.00 | $22.35 | $46.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.71 / $36.15 / $138.07
| Facility | | $18.71 | $36.15 | $138.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.04 / $27.04 / $90.00
| Facility | | $27.04 | $27.04 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $23.53 / $33.53
| Professional | | $22.35 | $23.53 | $33.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.85 / $33.11 / $52.87
| Facility | | $13.85 | $33.11 | $52.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $23.53 / $33.72
| Professional | | $22.35 | $23.53 | $33.72 |