- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.01 / $19.01 / $19.01
| Facility | | $19.01 | $19.01 | $19.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $19.01 / $33.15
| Professional | | $19.01 | $19.01 | $33.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.47 / $134.11 / $214.99
| Facility | | $40.47 | $134.11 | $214.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.80 / $34.45 / $46.02
| Professional | | $17.80 | $34.45 | $46.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.02 / $56.79 / $73.13
| Facility | | $48.02 | $56.79 | $73.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.87 / $30.16 / $30.16
| Professional | | $25.87 | $30.16 | $30.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.14 / $29.14 / $29.14
| Facility | | $29.14 | $29.14 | $29.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.27 / $29.14 / $52.50
| Professional | | $21.27 | $29.14 | $52.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $34.85 / $36.59
| Professional | | $34.85 | $34.85 | $36.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.33 / $36.33 / $36.33
| Professional | | $36.33 | $36.33 | $36.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.88 / $214.99 / $214.99
| Facility | | $91.88 | $214.99 | $214.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.16 / $21.32 / $55.98
| Professional | | $17.16 | $21.32 | $55.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.59 / $26.10 / $31.10
| Facility | | $17.59 | $26.10 | $31.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $22.13 / $45.26
| Professional | | $17.70 | $22.13 | $45.26 |