- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $40.74 / $97.72
| Professional | | $33.11 | $40.74 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $77.62 / $478.63
| Facility | | $67.61 | $77.62 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $58.88 / $77.62
| Professional | | $32.36 | $58.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $131.83
| Facility | | $43.65 | $43.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $63.10 / $63.10
| Professional | | $50.12 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $48.98 / $53.70
| Facility | | $43.65 | $48.98 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $48.98
| Professional | | $35.48 | $35.48 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $100.00
| Professional | | $66.07 | $66.07 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $45.71
| Professional | | $44.67 | $44.67 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $77.62 / $478.63
| Facility | | $67.61 | $77.62 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $58.88 / $85.11
| Professional | | $32.36 | $58.88 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.06 / $47.86 / $102.33
| Facility | | $0.06 | $47.86 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $44.67 / $66.07
| Professional | | $31.62 | $44.67 | $66.07 |