- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.63 / $36.63 / $36.63
| Facility | | $36.63 | $36.63 | $36.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.63 / $38.08 / $66.87
| Professional | | $36.63 | $38.08 | $66.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.06 / $151.63 / $415.88
| Facility | | $48.06 | $151.63 | $415.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $60.43 / $81.84
| Professional | | $38.90 | $60.43 | $81.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.49 / $48.49 / $144.02
| Facility | | $48.49 | $48.49 | $144.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.38 / $74.38 / $74.38
| Professional | | $60.38 | $74.38 | $74.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.49 / $48.73 / $58.76
| Facility | | $48.49 | $48.73 | $58.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.57 / $48.73 / $90.38
| Professional | | $35.57 | $48.73 | $90.38 |
- 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
- $67.87 / $67.87 / $71.26
| Professional | | $67.87 | $67.87 | $71.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.08 / $57.08 / $57.08
| Professional | | $57.08 | $57.08 | $57.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.30 / $415.88 / $415.88
| Facility | | $158.30 | $415.88 | $415.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.74 / $44.81 / $81.84
| Professional | | $32.74 | $44.81 | $81.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.97 / $39.97 / $39.97
| Facility | | $39.97 | $39.97 | $39.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $44.81 / $77.98
| Professional | | $36.40 | $44.81 | $77.98 |