- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.53 / $29.45 / $79.73
| Facility | | $21.53 | $29.45 | $79.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $21.73 / $31.21
| Professional | | $21.53 | $21.73 | $31.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.80 / $71.33 / $875.64
| Facility | | $45.80 | $71.33 | $875.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $22.82 / $1,010.62
| Professional | | $21.53 | $22.82 | $1,010.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.08 / $26.44 / $51.37
| Facility | | $23.08 | $26.44 | $51.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.03 / $34.29 / $46.84
| Professional | | $24.03 | $34.29 | $46.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.52 / $21.52 / $21.52
| Facility | | $21.52 | $21.52 | $21.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.52 / $21.52 / $23.29
| Professional | | $21.52 | $21.52 | $23.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.62 / $53.00 / $8,090.00
| Facility | | $25.62 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $21.53 / $245.96
| Professional | | $21.53 | $21.53 | $245.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $21.53 / $24.92
| Professional | | $21.53 | $21.53 | $24.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.54 / $117.32 / $200.88
| Facility | | $69.54 | $117.32 | $200.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $875.64 / $875.64
| Facility | | $75.00 | $875.64 | $875.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $22.82 / $1,010.62
| Professional | | $21.53 | $22.82 | $1,010.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $22.76 / $43.19
| Professional | | $21.53 | $22.76 | $43.19 |