- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $45.71 / $107.15
| Professional | | $37.15 | $45.71 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $104.71 / $537.03
| Facility | | $91.20 | $104.71 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $74.13 / $104.71
| Professional | | $42.66 | $74.13 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $58.88 / $177.83
| Facility | | $58.88 | $58.88 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $91.20 / $91.20
| Professional | | $74.13 | $91.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $60.26 / $72.44
| Facility | | $58.88 | $60.26 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $60.26
| Professional | | $43.65 | $43.65 | $60.26 |
- 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
- $89.13 / $89.13 / $134.90
| Professional | | $89.13 | $89.13 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $104.71 / $537.03
| Facility | | $91.20 | $104.71 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $77.62 / $114.82
| Professional | | $43.65 | $77.62 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.07 / $63.10 / $114.82
| Facility | | $0.07 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $63.10 / $89.13
| Professional | | $41.69 | $63.10 | $89.13 |