- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $61.66
| Professional | | $30.20 | $30.20 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $50.12 / $181.97
| Facility | | $37.15 | $50.12 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $37.15 / $66.07
| Professional | | $22.39 | $37.15 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $30.20 / $30.20
| Professional | | $29.51 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Professional | | $14.79 | $14.79 | $14.79 |
- 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
- $33.11 / $33.11 / $42.66
| Professional | | $33.11 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $50.12 / $181.97
| Facility | | $37.15 | $50.12 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $37.15 / $66.07
| Professional | | $22.39 | $37.15 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $41.69
| Professional | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $38.90 / $38.90
| Facility | | $29.51 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $29.51 / $37.15
| Professional | | $20.42 | $29.51 | $37.15 |