- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.00 / $25.00 / $30.73
| Facility | | $25.00 | $25.00 | $30.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.76 / $19.57 / $28.21
| Professional | | $18.76 | $19.57 | $28.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.73 / $101.99 / $254.84
| Facility | | $30.73 | $101.99 | $254.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.73 / $66.08 / $256.41
| Professional | | $30.73 | $66.08 | $256.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.47 / $59.81 / $71.11
| Facility | | $36.47 | $59.81 | $71.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.02 / $37.81 / $83.93
| Professional | | $29.02 | $37.81 | $83.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.84 / $30.09 / $69.00
| Professional | | $21.84 | $30.09 | $69.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.73 / $30.73 / $30.73
| Facility | | $30.73 | $30.73 | $30.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.73 / $30.73 / $78.95
| Professional | | $30.73 | $30.73 | $78.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.04 / $60.33 / $87.23
| Professional | | $30.04 | $60.33 | $87.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.12 / $122.92 / $336.00
| Professional | | $61.12 | $122.92 | $336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.99 / $101.99 / $254.84
| Facility | | $101.99 | $101.99 | $254.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.47 / $100.94 / $256.41
| Professional | | $46.47 | $100.94 | $256.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.73 / $30.73 / $35.34
| Professional | | $30.73 | $30.73 | $35.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.55 / $71.34 / $184.31
| Professional | | $41.55 | $71.34 | $184.31 |