- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $15.49 / $23.44
| Professional | | $10.23 | $15.49 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $47.86 / $69.18
| Facility | | $38.02 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $13.80
| Professional | | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $1.51
| Facility | | $0.56 | $0.56 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $15.85 / $19.50
| Professional | | $14.79 | $15.85 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $40.74
| Professional | | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $33.11
| Professional | | $11.22 | $11.22 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $63.10 / $74.13
| Facility | | $25.12 | $63.10 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $15.49 / $23.44
| Professional | | $10.23 | $15.49 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $14.45 / $23.44
| Facility | | $12.02 | $14.45 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.45 / $39.81
| Professional | | $10.00 | $14.45 | $39.81 |