- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $20.82 / $20.82
| Facility | | $20.82 | $20.82 | $20.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.82 / $21.32 / $40.06
| Professional | | $20.82 | $21.32 | $40.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.50 / $99.39 / $301.82
| Facility | | $31.50 | $99.39 | $301.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.27 / $36.64 / $46.54
| Professional | | $23.27 | $36.64 | $46.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.57 / $27.57 / $81.88
| Facility | | $27.57 | $27.57 | $81.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $42.28 / $42.28
| Professional | | $34.32 | $42.28 | $42.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.57 / $29.78 / $33.40
| Facility | | $27.57 | $29.78 | $33.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.74 / $29.77 / $55.13
| Professional | | $21.74 | $29.77 | $55.13 |
- 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
- $38.58 / $38.58 / $40.51
| Professional | | $38.58 | $38.58 | $40.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.29 / $30.29 / $30.29
| Professional | | $30.29 | $30.29 | $30.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.93 / $301.82 / $301.82
| Facility | | $136.93 | $301.82 | $301.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.70 / $25.72 / $46.54
| Professional | | $19.70 | $25.72 | $46.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.70 / $26.57 / $46.54
| Professional | | $20.70 | $26.57 | $46.54 |