- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.66 / $51.66 / $51.66
| Facility | | $51.66 | $51.66 | $51.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $48.88 / $61.66
| Professional | | $40.86 | $48.88 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.44 / $281.44 / $281.44
| Facility | | $281.44 | $281.44 | $281.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.02 / $98.55 / $432.81
| Professional | | $54.02 | $98.55 | $432.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.57 / $72.02 / $72.02
| Professional | | $61.57 | $72.02 | $72.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $83.43 / $6,679.00
| Facility | | $60.00 | $83.43 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.74 / $113.42 / $178.04
| Professional | | $92.74 | $113.42 | $178.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.79 / $105.71 / $194.40
| Professional | | $65.79 | $105.71 | $194.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.44 / $281.44 / $281.44
| Facility | | $281.44 | $281.44 | $281.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.02 / $98.55 / $432.81
| Professional | | $54.02 | $98.55 | $432.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.02 / $70.48 / $165.31
| Professional | | $54.02 | $70.48 | $165.31 |