- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.63 / $23.63 / $23.63
| Facility | | $23.63 | $23.63 | $23.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.53 / $23.63 / $45.29
| Professional | | $17.53 | $23.63 | $45.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.38 / $160.28 / $256.88
| Facility | | $48.38 | $160.28 | $256.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.28 / $41.58 / $54.92
| Professional | | $24.28 | $41.58 | $54.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.04 / $69.83 / $89.92
| Facility | | $59.04 | $69.83 | $89.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.42 / $37.09 / $37.09
| Professional | | $35.42 | $37.09 | $37.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.21 / $36.21 / $36.21
| Facility | | $36.21 | $36.21 | $36.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.43 / $36.21 / $62.63
| Professional | | $26.43 | $36.21 | $62.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.09 / $44.09 / $46.29
| Professional | | $44.09 | $44.09 | $46.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.86 / $106.86 / $130.08
| Facility | | $106.86 | $106.86 | $130.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.61 / $43.36 / $43.36
| Professional | | $35.61 | $43.36 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.78 / $256.88 / $256.88
| Facility | | $109.78 | $256.88 | $256.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $28.91 / $73.63
| Professional | | $21.12 | $28.91 | $73.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $40.50 / $49.12
| Professional | | $38.86 | $40.50 | $49.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.12 / $28.91 / $54.08
| Professional | | $21.12 | $28.91 | $54.08 |