- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $40.74 / $63.10
| Professional | | $28.84 | $40.74 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $64.57 / $316.23
| Facility | | $63.10 | $64.57 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $50.12 / $67.61
| Professional | | $25.70 | $50.12 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $138.04
| Facility | | $45.71 | $45.71 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $46.77 / $46.77
| Professional | | $41.69 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $39.81 / $46.77
| Facility | | $36.31 | $39.81 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $48.98
| Professional | | $33.88 | $33.88 | $48.98 |
- 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
- $57.54 / $57.54 / $89.13
| Professional | | $57.54 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $64.57 / $316.23
| Facility | | $63.10 | $64.57 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $51.29 / $74.13
| Professional | | $25.70 | $51.29 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $25.70 / $38.02
| Facility | | $0.05 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $38.02 / $57.54
| Professional | | $25.12 | $38.02 | $57.54 |