- 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
- $28.18 / $34.67 / $64.57
| Professional | | $28.18 | $34.67 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $74.13 / $354.81
| Facility | | $64.57 | $74.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $51.29 / $74.13
| Professional | | $30.90 | $51.29 | $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
- $47.86 / $64.57 / $64.57
| Professional | | $47.86 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $44.67 / $50.12
| Facility | | $41.69 | $44.67 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $44.67
| Professional | | $33.11 | $33.11 | $44.67 |
- 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
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $74.13 / $354.81
| Facility | | $64.57 | $74.13 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $54.95 / $83.18
| Professional | | $31.62 | $54.95 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $45.71 / $83.18
| Facility | | $0.05 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $63.10
| Professional | | $30.20 | $45.71 | $63.10 |