- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $42.66 / $77.62
| Professional | | $34.67 | $42.66 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $85.11 / $416.87
| Facility | | $74.13 | $85.11 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $63.10 / $85.11
| Professional | | $38.02 | $63.10 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $147.91
| Facility | | $48.98 | $48.98 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $74.13 / $74.13
| Professional | | $60.26 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $58.88
| Facility | | $48.98 | $48.98 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $48.98
| Professional | | $35.48 | $35.48 | $48.98 |
- 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
- $74.13 / $74.13 / $112.20
| Professional | | $74.13 | $74.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $85.11 / $416.87
| Facility | | $74.13 | $85.11 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $63.10 / $95.50
| Professional | | $38.90 | $63.10 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.06 / $58.88 / $107.15
| Facility | | $0.06 | $58.88 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $57.54 / $74.13
| Professional | | $36.31 | $57.54 | $74.13 |