- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.10 / $18.10 / $18.10
| Facility | | $18.10 | $18.10 | $18.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.91 / $15.00 / $28.97
| Professional | | $13.91 | $15.00 | $28.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.37 / $80.00 / $172.90
| Facility | | $16.37 | $80.00 | $172.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $40.96 / $174.02
| Professional | | $16.37 | $40.96 | $174.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.55 / $59.81 / $71.11
| Facility | | $19.55 | $59.81 | $71.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.56 / $19.82 / $35.47
| Professional | | $15.56 | $19.82 | $35.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $16.89 / $40.44
| Professional | | $10.50 | $16.89 | $40.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.37 / $16.37 / $16.37
| Facility | | $16.37 | $16.37 | $16.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $16.37 / $53.63
| Professional | | $16.37 | $16.37 | $53.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.01 / $32.14 / $46.46
| Professional | | $16.01 | $32.14 | $46.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.48 / $163.69 / $360.14
| Professional | | $65.48 | $163.69 | $360.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $172.90
| Facility | | $80.00 | $80.00 | $172.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.56 / $69.62 / $174.02
| Professional | | $31.56 | $69.62 | $174.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.37 / $16.37 / $21.00
| Professional | | $16.37 | $16.37 | $21.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.49 / $124.49 / $124.49
| Facility | | $124.49 | $124.49 | $124.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.19 / $49.15 / $127.12
| Professional | | $23.19 | $49.15 | $127.12 |