- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $37.15 / $83.18
| Professional | | $32.36 | $37.15 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $87.10 / $407.38
| Facility | | $66.07 | $87.10 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $60.26 / $87.10
| Professional | | $34.67 | $60.26 | $87.10 |
- 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
- $50.12 / $74.13 / $74.13
| Professional | | $50.12 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $48.98 / $60.26
| Facility | | $47.86 | $48.98 | $60.26 |
- 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
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $87.10 / $407.38
| Facility | | $66.07 | $87.10 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $63.10 / $95.50
| Professional | | $34.67 | $63.10 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.05 / $47.86 / $87.10
| Facility | | $0.05 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $47.86 / $74.13
| Professional | | $32.36 | $47.86 | $74.13 |