- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.11 / $522.35 / $1,887.42
| Facility | | $18.11 | $522.35 | $1,887.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.82 / $24.87
| Professional | | $18.11 | $18.82 | $24.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.53 / $48.53 / $164.81
| Facility | | $16.53 | $48.53 | $164.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $22.90
| Professional | | $18.11 | $18.11 | $22.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.43 / $23.11 / $49.26
| Facility | | $19.43 | $23.11 | $49.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $18.11
| Facility | | $18.11 | $18.11 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $18.11
| Professional | | $18.11 | $18.11 | $18.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.39 / $53.00 / $8,090.00
| Facility | | $18.39 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $37.61
| Professional | | $18.11 | $18.11 | $37.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.64 / $56.25 / $863.97
| Facility | | $27.64 | $56.25 | $863.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $164.81
| Facility | | $75.00 | $75.00 | $164.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $27.17
| Professional | | $18.11 | $18.11 | $27.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.77 / $12.95 / $26.25
| Facility | | $11.77 | $12.95 | $26.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $25.35
| Professional | | $18.11 | $18.11 | $25.35 |