- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.30 / $28.30 / $28.30
| Facility | | $28.30 | $28.30 | $28.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.67 / $28.30 / $36.47
| Professional | | $19.67 | $28.30 | $36.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.27 / $141.15 / $181.21
| Facility | | $43.27 | $141.15 | $181.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.29 / $37.54 / $48.15
| Professional | | $22.29 | $37.54 | $48.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.72 / $83.63 / $107.70
| Facility | | $70.72 | $83.63 | $107.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.15 / $43.80 / $43.80
| Professional | | $38.15 | $43.80 | $43.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.15 / $38.15 / $42.22
| Facility | | $38.15 | $38.15 | $42.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.43 / $38.15 / $62.80
| Professional | | $32.43 | $38.15 | $62.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $52.44 / $55.06
| Professional | | $52.44 | $52.44 | $55.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.79 / $37.79 / $37.79
| Professional | | $37.79 | $37.79 | $37.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.98 / $181.21 / $181.21
| Facility | | $79.98 | $181.21 | $181.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.23 / $32.31 / $50.19
| Professional | | $21.23 | $32.31 | $50.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.78 / $64.78 / $64.78
| Facility | | $64.78 | $64.78 | $64.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.54 / $32.31 / $52.44
| Professional | | $21.54 | $32.31 | $52.44 |