- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.37 / $15.37 / $59.48
| Facility | | $15.37 | $15.37 | $59.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $17.01 / $20.68
| Professional | | $14.62 | $17.01 | $20.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.45 / $37.36 / $37.36
| Professional | | $28.45 | $37.36 | $37.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $37.36
| Facility | | $21.38 | $21.38 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $32.71
| Professional | | $15.61 | $15.61 | $32.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.36 / $37.36 / $70.98
| Professional | | $34.36 | $37.36 | $70.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.37 / $15.37 / $59.48
| Facility | | $15.37 | $15.37 | $59.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $17.66 / $24.07
| Professional | | $14.62 | $17.66 | $24.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.30 / $53.20 / $73.59
| Professional | | $46.30 | $53.20 | $73.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $37.36
| Facility | | $21.38 | $21.38 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $44.25
| Professional | | $15.61 | $15.61 | $44.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.70 / $35.56 / $35.56
| Facility | | $26.70 | $35.56 | $35.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.70 / $35.56 / $36.46
| Professional | | $26.70 | $35.56 | $36.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $18.72 / $33.68
| Professional | | $14.46 | $18.72 | $33.68 |