- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.31 / $40.31 / $40.31
| Facility | | $40.31 | $40.31 | $40.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.31 / $44.43 / $59.42
| Professional | | $40.31 | $44.43 | $59.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.26 / $250.98 / $584.29
| Facility | | $43.26 | $250.98 | $584.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.20 / $70.25 / $90.10
| Professional | | $41.20 | $70.25 | $90.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.93 / $119.14 / $153.43
| Facility | | $97.93 | $119.14 | $153.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.42 / $76.81 / $76.81
| Professional | | $60.42 | $76.81 | $76.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.87 / $62.72 / $64.68
| Facility | | $53.87 | $62.72 | $64.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.79 / $62.72 / $112.88
| Professional | | $45.79 | $62.72 | $112.88 |
- 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
- $74.69 / $74.69 / $78.42
| Professional | | $74.69 | $74.69 | $78.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.40 / $63.40 / $63.40
| Facility | | $63.40 | $63.40 | $63.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.40 / $63.40 / $63.40
| Professional | | $63.40 | $63.40 | $63.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.98 / $584.29 / $584.29
| Facility | | $250.98 | $584.29 | $584.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $49.32 / $90.10
| Professional | | $35.47 | $49.32 | $90.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.01 / $123.01 / $123.01
| Facility | | $123.01 | $123.01 | $123.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.04 / $49.32 / $90.10
| Professional | | $36.04 | $49.32 | $90.10 |