- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $33.11 / $79.43
| Professional | | $21.88 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $281.84
| Facility | | $44.67 | $57.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $42.66 / $125.89
| Professional | | $27.54 | $42.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $79.43 / $104.71
| Facility | | $67.61 | $79.43 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $38.90 / $38.90
| Professional | | $38.02 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Professional | | $30.90 | $30.90 | $30.90 |
- 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
- $52.48 / $52.48 / $58.88
| Professional | | $52.48 | $52.48 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $281.84
| Facility | | $44.67 | $57.54 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $42.66 / $125.89
| Professional | | $27.54 | $42.66 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $37.15
| Facility | | $34.67 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $34.67 / $52.48
| Professional | | $25.70 | $34.67 | $52.48 |