- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $18.48 / $9,539.36
| Facility | | $13.49 | $18.48 | $9,539.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $18.78
| Professional | | $13.49 | $13.49 | $18.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.43 / $40.27 / $101.35
| Facility | | $17.43 | $40.27 | $101.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.16 / $102.03
| Professional | | $13.49 | $14.16 | $102.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.46 / $16.57 / $32.19
| Facility | | $14.46 | $16.57 | $32.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.45 / $13.49 / $13.49
| Facility | | $13.45 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $14.67
| Professional | | $13.49 | $13.49 | $14.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $53.00 / $8,090.00
| Facility | | $13.49 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $13.49
| Professional | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $15.61
| Professional | | $13.49 | $13.49 | $15.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,101.73 / $4,316.39 / $6,137.68
| Facility | | $3,101.73 | $4,316.39 | $6,137.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,716.20 / $2,716.20 / $2,716.20
| Professional | | $2,716.20 | $2,716.20 | $2,716.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $101.35 / $101.35
| Facility | | $75.00 | $101.35 | $101.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.30 / $102.03
| Professional | | $13.49 | $14.30 | $102.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.30 / $25.24
| Professional | | $13.49 | $14.30 | $25.24 |