- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Facility | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $28.84 / $67.61
| Professional | | $20.89 | $28.84 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $50.12 / $257.04
| Facility | | $38.90 | $50.12 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $38.02 / $50.12
| Professional | | $22.39 | $38.02 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $87.10
| Facility | | $28.84 | $28.84 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Professional | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $31.62 / $34.67
| Facility | | $28.84 | $31.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $31.62
| Professional | | $23.44 | $23.44 | $31.62 |
- 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
- $43.65 / $43.65 / $66.07
| Professional | | $43.65 | $43.65 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $50.12 / $257.04
| Facility | | $38.90 | $50.12 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $38.02 / $58.88
| Professional | | $22.39 | $38.02 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $26.30 / $67.61
| Facility | | $0.04 | $26.30 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $30.20 / $43.65
| Professional | | $20.42 | $30.20 | $43.65 |