- 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 / $42.66 / $66.07
| Professional | | $30.20 | $42.66 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $67.61 / $331.13
| Facility | | $66.07 | $67.61 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $53.70 / $102.33
| Professional | | $27.54 | $53.70 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $144.54
| Facility | | $47.86 | $47.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $44.67 / $44.67
| Professional | | $43.65 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $38.02 / $38.90
| Facility | | $38.02 | $38.02 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $32.36 / $45.71
| Professional | | $28.18 | $32.36 | $45.71 |
- 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
- $61.66 / $61.66 / $93.33
| Professional | | $61.66 | $61.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $67.61 / $331.13
| Facility | | $66.07 | $67.61 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $57.54 / $107.15
| Professional | | $27.54 | $57.54 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $26.92 / $44.67
| Facility | | $0.05 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $39.81 / $66.07
| Professional | | $27.54 | $39.81 | $66.07 |