- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Facility | | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $42.66 / $85.11
| Professional | | $28.84 | $42.66 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $74.13 / $380.19
| Facility | | $64.57 | $74.13 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $54.95 / $74.13
| Professional | | $32.36 | $54.95 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $125.89
| Facility | | $41.69 | $41.69 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $58.88 / $58.88
| Professional | | $46.77 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $52.48 / $52.48
| Facility | | $41.69 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $56.23
| Professional | | $38.90 | $38.90 | $56.23 |
- 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
- $63.10 / $63.10 / $95.50
| Professional | | $63.10 | $63.10 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $74.13 / $380.19
| Facility | | $64.57 | $74.13 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $54.95 / $81.28
| Professional | | $32.36 | $54.95 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.06 / $40.74 / $97.72
| Facility | | $0.06 | $40.74 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $42.66 / $63.10
| Professional | | $29.51 | $42.66 | $63.10 |