- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.58 / $31.58 / $31.58
| Facility | | $31.58 | $31.58 | $31.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.58 / $31.58 / $51.54
| Professional | | $31.58 | $31.58 | $51.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.25 / $141.04 / $353.88
| Facility | | $47.25 | $141.04 | $353.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.39 / $48.52 / $70.59
| Professional | | $31.39 | $48.52 | $70.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.80 / $41.80 / $124.15
| Facility | | $41.80 | $41.80 | $124.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.32 / $64.13 / $64.13
| Professional | | $47.32 | $64.13 | $64.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.80 / $44.94 / $50.67
| Facility | | $41.80 | $44.94 | $50.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.81 / $44.94 / $80.63
| Professional | | $32.81 | $44.94 | $80.63 |
- 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
- $58.53 / $58.53 / $61.46
| Professional | | $58.53 | $58.53 | $61.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.95 / $38.95 / $38.95
| Professional | | $38.95 | $38.95 | $38.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.04 / $353.88 / $353.88
| Facility | | $141.04 | $353.88 | $353.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.24 / $38.63 / $70.59
| Professional | | $28.24 | $38.63 | $70.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.24 / $37.24 / $37.24
| Facility | | $37.24 | $37.24 | $37.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.24 / $38.63 / $70.59
| Professional | | $28.24 | $38.63 | $70.59 |