- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.40 / $35.40 / $35.40
| Facility | | $35.40 | $35.40 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.57 / $36.07 / $48.75
| Professional | | $25.57 | $36.07 | $48.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.71 / $160.41 / $414.11
| Facility | | $42.71 | $160.41 | $414.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.65 / $51.73 / $79.13
| Professional | | $31.65 | $51.73 | $79.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.01 / $104.64 / $134.76
| Facility | | $86.01 | $104.64 | $134.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.65 / $74.98 / $113.82
| Professional | | $51.65 | $74.98 | $113.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.70 / $46.87 / $59.57
| Facility | | $46.70 | $46.87 | $59.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.09 / $46.70 / $81.19
| Professional | | $34.09 | $46.70 | $81.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.61 / $65.61 / $68.89
| Professional | | $65.61 | $65.61 | $68.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.94 / $41.94 / $41.94
| Professional | | $41.94 | $41.94 | $41.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.41 / $414.11 / $414.11
| Facility | | $160.41 | $414.11 | $414.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.19 / $40.43 / $79.13
| Professional | | $27.19 | $40.43 | $79.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.18 / $87.18 / $87.18
| Facility | | $87.18 | $87.18 | $87.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.61 / $40.43 / $75.09
| Professional | | $29.61 | $40.43 | $75.09 |