- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.90 / $10.90 / $10.90
| Facility | | $10.90 | $10.90 | $10.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.90 / $12.06 / $20.18
| Professional | | $10.90 | $12.06 | $20.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.17 / $47.87 / $147.82
| Facility | | $15.17 | $47.87 | $147.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.65 / $17.98 / $24.37
| Professional | | $11.65 | $17.98 | $24.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.59 / $37.22 / $47.71
| Facility | | $30.59 | $37.22 | $47.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.35 / $21.73 / $21.73
| Professional | | $16.35 | $21.73 | $21.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $16.29 / $17.51
| Facility | | $14.45 | $16.29 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.89 / $11.89 / $29.25
| Professional | | $11.89 | $11.89 | $29.25 |
- 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
- $20.20 / $20.20 / $21.21
| Professional | | $20.20 | $20.20 | $21.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.50 / $88.50 / $88.50
| Facility | | $88.50 | $88.50 | $88.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $16.44
| Professional | | $14.75 | $14.75 | $16.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.12 / $147.82 / $147.82
| Facility | | $51.12 | $147.82 | $147.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.75 / $13.34 / $24.37
| Professional | | $9.75 | $13.34 | $24.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.12 / $31.12 / $31.12
| Facility | | $31.12 | $31.12 | $31.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $13.34 / $24.37
| Professional | | $10.84 | $13.34 | $24.37 |