- 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 / $25.20
| Professional | | $18.76 | $19.57 | $25.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.73 / $80.00 / $183.45
| Facility | | $30.73 | $80.00 | $183.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $57.54 / $180.95
| Professional | | $27.43 | $57.54 | $180.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.71 / $59.81 / $71.11
| Facility | | $41.71 | $59.81 | $71.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.18 / $42.27 / $84.78
| Professional | | $33.18 | $42.27 | $84.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.57 / $25.45 / $40.44
| Professional | | $19.57 | $25.45 | $40.44 |
- 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 / $52.56
| Professional | | $30.73 | $30.73 | $52.56 |
- 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
- $30.73 / $92.19 / $190.00
| Professional | | $30.73 | $92.19 | $190.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $183.45
| Facility | | $80.00 | $80.00 | $183.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.59 / $71.79 / $180.95
| Professional | | $33.59 | $71.79 | $180.95 |
- 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
- $25.09 / $51.19 / $143.61
| Professional | | $25.09 | $51.19 | $143.61 |