- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.77 / $33.58 / $51.54
| Facility | | $25.77 | $33.58 | $51.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $25.77 / $28.72
| Professional | | $25.77 | $25.77 | $28.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.65 / $75.00 / $311.20
| Facility | | $38.65 | $75.00 | $311.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $27.06 / $101.56
| Professional | | $25.77 | $27.06 | $101.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.63 / $31.65 / $61.49
| Facility | | $27.63 | $31.65 | $61.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.00 / $25.77 / $25.77
| Facility | | $23.00 | $25.77 | $25.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $25.77 / $25.77
| Professional | | $25.77 | $25.77 | $25.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.77 / $53.00 / $8,090.00
| Facility | | $25.77 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $38.75 / $45.58
| Professional | | $25.77 | $38.75 | $45.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $25.77 / $25.77
| Professional | | $25.77 | $25.77 | $25.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.92 / $930.81 / $1,933.37
| Facility | | $122.92 | $930.81 | $1,933.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $311.20 / $311.20
| Facility | | $75.00 | $311.20 | $311.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $27.32 / $101.56
| Professional | | $25.77 | $27.32 | $101.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.30 / $42.56 / $94.99
| Facility | | $25.30 | $42.56 | $94.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $25.77 / $60.82
| Professional | | $25.77 | $25.77 | $60.82 |