- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.69 / $51.87 / $73.38
| Facility | | $36.69 | $51.87 | $73.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $36.69 / $44.03
| Professional | | $36.69 | $36.69 | $44.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.88 / $98.33 / $205.70
| Facility | | $37.88 | $98.33 | $205.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $38.52 / $167.55
| Professional | | $36.69 | $38.52 | $167.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.33 / $45.06 / $87.54
| Facility | | $39.33 | $45.06 | $87.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $36.69 / $36.69
| Facility | | $36.58 | $36.69 | $36.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $36.69 / $36.69
| Professional | | $36.69 | $36.69 | $36.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.70 / $73.92 / $8,090.00
| Facility | | $37.70 | $73.92 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $36.69 / $36.69
| Professional | | $36.69 | $36.69 | $36.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $36.69 / $42.46
| Professional | | $36.69 | $36.69 | $42.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,708.03 / $16,771.87 / $18,151.34
| Facility | | $6,708.03 | $16,771.87 | $18,151.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $205.70 / $205.70
| Facility | | $75.00 | $205.70 | $205.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $38.89 / $167.55
| Professional | | $36.69 | $38.89 | $167.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $38.89 / $48.75
| Professional | | $36.69 | $38.89 | $48.75 |