- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.26 / $7.26 / $7.26
| Facility | | $7.26 | $7.26 | $7.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.55 / $7.27 / $7.83
| Professional | | $5.55 | $7.27 | $7.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $30.37 / $30.37
| Professional | | $30.37 | $30.37 | $30.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.33 / $7.33 / $11.00
| Professional | | $7.33 | $7.33 | $11.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $6.05 / $6.05
| Professional | | $6.05 | $6.05 | $6.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $90.00 / $90.00
| Facility | | $90.00 | $90.00 | $90.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.55 / $5.55 / $7.83
| Facility | | $5.55 | $5.55 | $7.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.68 / $341.05 / $392.35
| Professional | | $36.68 | $341.05 | $392.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,281.21 / $1,411.59 / $1,523.02
| Facility | | $1,281.21 | $1,411.59 | $1,523.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.55 / $5.55 / $7.83
| Facility | | $5.55 | $5.55 | $7.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $6.05 / $6.05
| Professional | | $6.05 | $6.05 | $6.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $7.94 / $12.71
| Professional | | $5.96 | $7.94 | $12.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $16.30 / $16.30
| Professional | | $16.30 | $16.30 | $16.30 |