- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $79.43 / $251.19
| Professional | | $64.57 | $79.43 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $154.88 / $707.95
| Facility | | $134.90 | $154.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $112.20 / $154.88
| Professional | | $63.10 | $112.20 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $263.03
| Facility | | $87.10 | $87.10 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $114.82 / $114.82
| Professional | | $107.15 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $104.71
| Facility | | $87.10 | $87.10 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $91.20
| Professional | | $63.10 | $63.10 | $91.20 |
- 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
- $131.83 / $131.83 / $199.53
| Professional | | $131.83 | $131.83 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Professional | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $154.88 / $707.95
| Facility | | $134.90 | $154.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $114.82 / $177.83
| Professional | | $63.10 | $114.82 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.11 / $75.86 / $186.21
| Facility | | $0.11 | $75.86 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $87.10 / $131.83
| Professional | | $58.88 | $87.10 | $131.83 |