- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $891.25
| Facility | | $47.86 | $47.86 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $724.44
| Professional | | $30.20 | $47.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $645.65 / $977.24
| Professional | | $524.81 | $645.65 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $812.83
| Professional | | $346.74 | $478.63 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $69.18 / $107.15
| Facility | | $57.54 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $57.54 / $95.50
| Professional | | $41.69 | $57.54 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Facility | | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $69.18 / $1,819.70
| Professional | | $30.90 | $69.18 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $70.79 / $660.69
| Professional | | $54.95 | $70.79 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $812.83
| Professional | | $478.63 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $1,819.70
| Professional | | $389.05 | $831.76 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,122.02 / $1,122.02
| Professional | | $562.34 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $60.26 / $93.33
| Professional | | $30.20 | $60.26 | $93.33 |