- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $63.10 / $154.88
| Professional | | $50.12 | $63.10 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $120.23 / $741.31
| Facility | | $91.20 | $120.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $89.13 / $120.23
| Professional | | $51.29 | $89.13 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $204.17
| Facility | | $67.61 | $67.61 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $89.13 / $89.13
| Professional | | $75.86 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $75.86 / $81.28
| Facility | | $67.61 | $75.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $75.86
| Professional | | $54.95 | $54.95 | $75.86 |
- 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
- $102.33 / $102.33 / $154.88
| Professional | | $102.33 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $120.23 / $741.31
| Facility | | $91.20 | $120.23 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $89.13 / $131.83
| Professional | | $51.29 | $89.13 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.09 / $66.07 / $158.49
| Facility | | $0.09 | $66.07 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $69.18 / $102.33
| Professional | | $47.86 | $69.18 | $102.33 |