- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $26.92 / $42.66
| Professional | | $19.05 | $26.92 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $44.67 / $213.80
| Facility | | $42.66 | $44.67 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $34.67 / $66.07
| Professional | | $17.78 | $34.67 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $57.54 / $75.86
| Facility | | $48.98 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $30.20 / $30.20
| Professional | | $25.70 | $30.20 | $30.20 |
- 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
- $21.38 / $21.38 / $33.88
| Professional | | $21.38 | $21.38 | $33.88 |
- 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
- $39.81 / $39.81 / $60.26
| Professional | | $39.81 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.66 / $44.67 / $213.80
| Facility | | $42.66 | $44.67 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $35.48 / $69.18
| Professional | | $18.20 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $26.30 / $30.90
| Facility | | $15.49 | $26.30 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $26.92 / $42.66
| Professional | | $17.78 | $26.92 | $42.66 |