- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.15 / $26.15 / $26.15
| Facility | | $26.15 | $26.15 | $26.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.38 / $26.15 / $38.31
| Professional | | $20.38 | $26.15 | $38.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.25 / $124.42 / $285.48
| Facility | | $26.25 | $124.42 | $285.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.81 / $40.29 / $58.44
| Professional | | $24.81 | $40.29 | $58.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.34 / $77.28 / $99.53
| Facility | | $65.34 | $77.28 | $99.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.72 / $38.72 / $84.24
| Professional | | $38.72 | $38.72 | $84.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.22 / $34.22 / $36.71
| Facility | | $34.22 | $34.22 | $36.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.98 / $34.22 / $70.88
| Professional | | $24.98 | $34.22 | $70.88 |
- 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
- $48.45 / $48.45 / $50.87
| Professional | | $48.45 | $48.45 | $50.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.14 / $24.14 / $24.14
| Facility | | $24.14 | $24.14 | $24.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.14 / $24.14 / $24.14
| Professional | | $24.14 | $24.14 | $24.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.42 / $285.48 / $285.48
| Facility | | $124.42 | $285.48 | $285.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $29.86 / $58.44
| Professional | | $22.77 | $29.86 | $58.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $31.99 / $59.84
| Professional | | $23.16 | $31.99 | $59.84 |