- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $30.00 / $30.00
| Professional | | $24.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.99 / $49.64 / $180.69
| Facility | | $36.99 | $49.64 | $180.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.16 / $36.93 / $189.44
| Professional | | $22.16 | $36.93 | $189.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.54 / $30.43 / $30.43
| Professional | | $29.54 | $30.43 | $30.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.93 / $36.93 / $36.93
| Facility | | $36.93 | $36.93 | $36.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.68 / $14.68 / $32.02
| Professional | | $14.68 | $14.68 | $32.02 |
- 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
- $49.64 / $49.64 / $49.64
| Professional | | $49.64 | $49.64 | $49.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.36 / $40.36 / $40.36
| Professional | | $40.36 | $40.36 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.75 / $35.75 / $35.75
| Professional | | $35.75 | $35.75 | $35.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $180.69
| Facility | | $80.00 | $80.00 | $180.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.30 / $29.54 / $189.44
| Professional | | $20.30 | $29.54 | $189.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.37 / $41.37 / $41.37
| Professional | | $41.37 | $41.37 | $41.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.77 / $22.16 / $55.40
| Professional | | $14.77 | $22.16 | $55.40 |