- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $117.49
| Facility | | $32.36 | $32.36 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $30.90 / $45.71
| Professional | | $25.12 | $30.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $43.65 / $100.00
| Professional | | $29.51 | $43.65 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $102.33 / $162.18
| Facility | | $87.10 | $102.33 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $83.18 / $125.89
| Professional | | $54.95 | $83.18 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $33.11 / $60.26
| Facility | | $26.30 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $66.07 / $89.13
| Professional | | $54.95 | $66.07 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $34.67 / $69.18
| Facility | | $26.30 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $50.12 / $194.98
| Professional | | $26.30 | $50.12 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $67.61
| Professional | | $32.36 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $77.62 / $114.82
| Professional | | $41.69 | $77.62 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $194.98 / $194.98
| Facility | | $74.13 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $194.98
| Professional | | $144.54 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Facility | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $58.88 / $112.20
| Professional | | $41.69 | $58.88 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $758.58
| Facility | | $575.44 | $575.44 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $38.02 / $91.20
| Professional | | $26.30 | $38.02 | $91.20 |