- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $30.90 / $31.62
| Facility | | $30.90 | $30.90 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $37.15 / $109.65
| Professional | | $28.84 | $37.15 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $87.10 / $104.71
| Facility | | $28.84 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $28.84 / $38.02
| Professional | | $0.10 | $28.84 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $69.18
| Facility | | $34.67 | $34.67 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- 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
- $14.79 / $17.38 / $35.48
| Professional | | $14.79 | $17.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $30.90 / $56.23
| Professional | | $26.30 | $30.90 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $87.10 / $104.71
| Facility | | $28.84 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $28.84 / $38.02
| Professional | | $0.10 | $28.84 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $58.88 / $77.62
| Facility | | $0.10 | $58.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $31.62 / $45.71
| Professional | | $0.10 | $31.62 | $45.71 |