- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.91 / $30.91 / $30.91
| Facility | | $30.91 | $30.91 | $30.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.91 / $30.91 / $39.89
| Professional | | $30.91 | $30.91 | $39.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.25 / $166.93 / $383.18
| Facility | | $47.25 | $166.93 | $383.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.64 / $47.87 / $69.09
| Professional | | $27.64 | $47.87 | $69.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.09 / $91.36 / $117.65
| Facility | | $75.09 | $91.36 | $117.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.32 / $58.90 / $58.90
| Professional | | $46.32 | $58.90 | $58.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.93 / $48.99 / $49.61
| Facility | | $40.93 | $48.99 | $49.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.76 / $48.99 / $86.25
| Professional | | $35.76 | $48.99 | $86.25 |
- 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
- $57.28 / $57.28 / $60.14
| Professional | | $57.28 | $57.28 | $60.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $38.44
| Facility | | $28.84 | $28.84 | $38.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.44 / $38.44 / $46.60
| Professional | | $38.44 | $38.44 | $46.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.93 / $383.18 / $383.18
| Facility | | $166.93 | $383.18 | $383.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.16 / $35.29 / $69.09
| Professional | | $25.16 | $35.29 | $69.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.58 / $35.29 / $61.84
| Professional | | $25.58 | $35.29 | $61.84 |