- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.75 / $41.77 / $88.02
| Facility | | $40.75 | $41.77 | $88.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.75 / $41.77 / $50.12
| Professional | | $40.75 | $41.77 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.46 / $38.46 / $38.46
| Professional | | $38.46 | $38.46 | $38.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Facility | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Professional | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.47 / $2,036.20 / $2,036.20
| Facility | | $67.47 | $2,036.20 | $2,036.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.88 / $227.88 / $297.00
| Professional | | $227.88 | $227.88 | $297.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.26 / $42.28 / $75.41
| Facility | | $34.26 | $42.28 | $75.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.10 / $38.21 / $61.89
| Professional | | $32.10 | $38.21 | $61.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $27.40 / $47.80
| Professional | | $27.40 | $27.40 | $47.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.26 / $42.28 / $75.41
| Facility | | $33.26 | $42.28 | $75.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Professional | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.53 / $42.96 / $45.12
| Professional | | $40.53 | $42.96 | $45.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.53 / $40.53 / $56.74
| Professional | | $40.53 | $40.53 | $56.74 |