- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $36.31 / $109.65
| Professional | | $30.20 | $36.31 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $72.44 / $338.84
| Facility | | $54.95 | $72.44 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $54.95 / $72.44
| Professional | | $31.62 | $54.95 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $91.20 / $123.03
| Facility | | $79.43 | $91.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $61.66 / $61.66
| Professional | | $41.69 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $52.48
| Facility | | $46.77 | $46.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $50.12
| Professional | | $33.88 | $33.88 | $50.12 |
- 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
- $61.66 / $61.66 / $93.33
| Professional | | $61.66 | $61.66 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $72.44 / $338.84
| Facility | | $54.95 | $72.44 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $54.95 / $72.44
| Professional | | $31.62 | $54.95 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $48.98 / $89.13
| Facility | | $0.05 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $46.77 / $61.66
| Professional | | $30.20 | $46.77 | $61.66 |