- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.47 / $72.93 / $102.74
| Facility | | $52.47 | $72.93 | $102.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $62.45
| Professional | | $52.47 | $52.47 | $62.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.36 / $144.87 / $262.35
| Facility | | $44.36 | $144.87 | $262.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $1,790.38
| Professional | | $52.47 | $52.47 | $1,790.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.25 / $64.43 / $125.19
| Facility | | $56.25 | $64.43 | $125.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.28 / $52.47 / $52.47
| Facility | | $50.28 | $52.47 | $52.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $52.47
| Professional | | $52.47 | $52.47 | $52.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.00 / $83.43 / $8,090.00
| Facility | | $53.00 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.63 / $27.63 / $52.47
| Professional | | $27.63 | $27.63 | $52.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $60.73
| Professional | | $52.47 | $52.47 | $60.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $262.35 / $262.35
| Facility | | $75.00 | $262.35 | $262.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $55.62 / $1,790.38
| Professional | | $52.47 | $55.62 | $1,790.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $52.47 / $67.95
| Professional | | $52.47 | $52.47 | $67.95 |