- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.17 / $12.17 / $12.17
| Facility | | $12.17 | $12.17 | $12.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $13.60 / $17.91
| Professional | | $12.12 | $13.60 | $17.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.67 / $42.19 / $132.24
| Facility | | $19.67 | $42.19 | $132.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $27.19 / $138.63
| Professional | | $13.60 | $27.19 | $138.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.30 / $35.95 / $46.09
| Facility | | $30.30 | $35.95 | $46.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.18 / $18.22 / $18.22
| Professional | | $17.18 | $18.22 | $18.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $16.94
| Professional | | $14.22 | $14.22 | $16.94 |
- 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
- $18.73 / $18.73 / $18.73
| Professional | | $18.73 | $18.73 | $18.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.52 / $132.24 / $132.24
| Facility | | $56.52 | $132.24 | $132.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.81 / $15.94 / $138.63
| Professional | | $11.81 | $15.94 | $138.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.88 / $15.94 / $31.35
| Professional | | $10.88 | $15.94 | $31.35 |