- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.47 / $25.47 / $25.47
| Facility | | $25.47 | $25.47 | $25.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $26.76 / $39.15
| Professional | | $25.47 | $26.76 | $39.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.76 / $164.48 / $365.18
| Facility | | $54.76 | $164.48 | $365.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.26 / $44.81 / $58.00
| Professional | | $26.26 | $44.81 | $58.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.45 / $86.94 / $111.46
| Facility | | $71.45 | $86.94 | $111.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.17 / $48.52 / $48.52
| Professional | | $38.17 | $48.52 | $48.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.72 / $38.57 / $40.86
| Facility | | $33.72 | $38.57 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.16 / $28.16 / $72.00
| Professional | | $28.16 | $28.16 | $72.00 |
- 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
- $47.20 / $47.20 / $49.56
| Professional | | $47.20 | $47.20 | $49.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.03 / $37.03 / $37.03
| Professional | | $37.03 | $37.03 | $37.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.12 / $365.18 / $365.18
| Facility | | $126.12 | $365.18 | $365.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $31.16 / $56.92
| Professional | | $22.41 | $31.16 | $56.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $24.24 / $32.28
| Facility | | $0.05 | $24.24 | $32.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $31.16 / $56.92
| Professional | | $22.77 | $31.16 | $56.92 |