- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.40 / $23.40 / $23.40
| Facility | | $23.40 | $23.40 | $23.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.40 / $25.80 / $38.60
| Professional | | $23.40 | $25.80 | $38.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.04 / $151.13 / $339.20
| Facility | | $27.04 | $151.13 | $339.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.13 / $40.78 / $52.30
| Professional | | $24.13 | $40.78 | $52.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.85 / $69.17 / $89.07
| Facility | | $56.85 | $69.17 | $89.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.07 / $44.59 / $44.59
| Professional | | $35.07 | $44.59 | $44.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.98 / $39.15 / $39.15
| Facility | | $30.98 | $39.15 | $39.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $39.15 / $70.13
| Professional | | $28.59 | $39.15 | $70.13 |
- 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
- $43.37 / $43.37 / $45.54
| Professional | | $43.37 | $43.37 | $45.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.03 / $34.03 / $34.03
| Facility | | $34.03 | $34.03 | $34.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.25 / $34.03 / $34.03
| Professional | | $31.25 | $34.03 | $34.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.23 / $339.20 / $339.20
| Facility | | $169.23 | $339.20 | $339.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.59 / $28.63 / $52.30
| Professional | | $20.59 | $28.63 | $52.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.23 / $51.23 / $51.23
| Facility | | $51.23 | $51.23 | $51.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $28.63 / $52.30
| Professional | | $22.14 | $28.63 | $52.30 |