- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.81 / $73.81 / $73.81
| Facility | | $73.81 | $73.81 | $73.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.81 / $73.81 / $96.00
| Professional | | $73.81 | $73.81 | $96.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.06 / $59.06 / $73.81
| Facility | | $59.06 | $59.06 | $73.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.43 / $66.43 / $66.43
| Professional | | $66.43 | $66.43 | $66.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.52 / $72.52 / $72.52
| Facility | | $72.52 | $72.52 | $72.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.52 / $72.52 / $72.52
| Professional | | $72.52 | $72.52 | $72.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.94 / $90.53 / $332.00
| Facility | | $50.94 | $90.53 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.64 / $81.09 / $130.22
| Professional | | $69.64 | $81.09 | $130.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.98 / $67.98 / $67.98
| Facility | | $67.98 | $67.98 | $67.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.98 / $67.98 / $73.81
| Professional | | $67.98 | $67.98 | $73.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.57 / $83.57 / $83.57
| Facility | | $83.57 | $83.57 | $83.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.52 / $555.00 / $74,999.25
| Facility | | $72.52 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.52 / $72.52 / $98.68
| Professional | | $72.52 | $72.52 | $98.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.81 / $77.70 / $107.32
| Professional | | $73.81 | $77.70 | $107.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.98 / $67.98 / $67.98
| Facility | | $67.98 | $67.98 | $67.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.98 / $67.98 / $73.81
| Professional | | $67.98 | $67.98 | $73.81 |