- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.17 / $20.17 / $20.17
| Facility | | $20.17 | $20.17 | $20.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.17 / $23.09 / $39.53
| Professional | | $20.17 | $23.09 | $39.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.09 / $101.42 / $220.66
| Facility | | $31.09 | $101.42 | $220.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $35.49 / $45.08
| Professional | | $21.12 | $35.49 | $45.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.15 / $91.15 / $270.72
| Facility | | $91.15 | $91.15 | $270.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.00 / $40.22 / $40.22
| Professional | | $34.00 | $40.22 | $40.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.59 / $30.59 / $30.59
| Facility | | $30.59 | $30.59 | $30.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.33 / $30.59 / $54.75
| Professional | | $22.33 | $30.59 | $54.75 |
- 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
- $37.36 / $37.36 / $39.24
| Professional | | $37.36 | $37.36 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.04 / $23.04 / $23.04
| Professional | | $23.04 | $23.04 | $23.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.98 / $220.66 / $220.66
| Facility | | $95.98 | $220.66 | $220.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.03 / $27.75 / $45.08
| Professional | | $18.03 | $27.75 | $45.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.45 / $56.45 / $56.45
| Facility | | $56.45 | $56.45 | $56.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $27.75 / $45.08
| Professional | | $20.80 | $27.75 | $45.08 |