- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.85 / $42.60 / $42.60
| Facility | | $34.85 | $42.60 | $42.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $38.39 / $50.17
| Professional | | $34.85 | $38.39 | $50.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.00 / $82.83 / $318.54
| Facility | | $25.00 | $82.83 | $318.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.20 / $61.50 / $146.68
| Professional | | $32.20 | $61.50 | $146.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.89 / $219.89 / $653.07
| Facility | | $219.89 | $219.89 | $653.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.23 / $119.23 / $172.83
| Professional | | $119.23 | $119.23 | $172.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.00 / $44.23 / $130.38
| Facility | | $17.00 | $44.23 | $130.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.60 / $37.60 / $97.50
| Professional | | $37.60 | $37.60 | $97.50 |
- 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
- $58.57 / $58.57 / $58.57
| Professional | | $58.57 | $58.57 | $58.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.16 / $0.16 / $0.16
| Professional | | $0.16 | $0.16 | $0.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.65 / $318.54 / $318.54
| Facility | | $179.65 | $318.54 | $318.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.20 / $46.47 / $630.37
| Professional | | $32.20 | $46.47 | $630.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.83 / $38.43 / $54.49
| Facility | | $26.83 | $38.43 | $54.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.28 / $42.60 / $130.38
| Professional | | $31.28 | $42.60 | $130.38 |