- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.47 / $75.04 / $109.17
| Facility | | $55.47 | $75.04 | $109.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $61.02
| Professional | | $55.47 | $55.47 | $61.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.53 / $148.66 / $277.35
| Facility | | $46.53 | $148.66 | $277.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $239.05
| Professional | | $55.47 | $55.47 | $239.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.46 / $68.12 / $132.35
| Facility | | $59.46 | $68.12 | $132.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.14 / $55.47 / $55.47
| Facility | | $54.14 | $55.47 | $55.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $55.47
| Professional | | $55.47 | $55.47 | $55.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.47 / $87.37 / $8,090.00
| Facility | | $55.47 | $87.37 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $55.47
| Professional | | $55.47 | $55.47 | $55.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $64.20
| Professional | | $55.47 | $55.47 | $64.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $277.35 / $277.35
| Facility | | $75.00 | $277.35 | $277.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $58.80 / $239.05
| Professional | | $55.47 | $58.80 | $239.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $55.47
| Facility | | $55.47 | $55.47 | $55.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.47 / $55.47 / $74.16
| Professional | | $55.47 | $55.47 | $74.16 |