- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $83.18
| Facility | | $37.15 | $37.15 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $47.86 / $131.83
| Professional | | $37.15 | $47.86 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $85.11 / $549.54
| Facility | | $81.28 | $85.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $66.07 / $89.13
| Professional | | $38.90 | $66.07 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $15,488.17
| Facility | | $5,128.61 | $5,128.61 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $58.88 / $58.88
| Professional | | $54.95 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Facility | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $57.54
| Professional | | $38.90 | $38.90 | $57.54 |
- 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
- $75.86 / $75.86 / $114.82
| Professional | | $75.86 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $85.11 / $549.54
| Facility | | $81.28 | $85.11 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $66.07 / $89.13
| Professional | | $38.90 | $66.07 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.07 / $48.98 / $117.49
| Facility | | $0.07 | $48.98 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $52.48 / $75.86
| Professional | | $35.48 | $52.48 | $75.86 |