- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $95.50
| Facility | | $95.50 | $95.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $104.71 / $208.93
| Professional | | $83.18 | $104.71 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $223.87 / $1,122.02
| Facility | | $194.98 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $158.49 / $223.87
| Professional | | $85.11 | $158.49 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $380.19
| Facility | | $125.89 | $125.89 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $169.82 / $169.82
| Professional | | $141.25 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $125.89 / $151.36
| Facility | | $112.20 | $125.89 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $125.89
| Professional | | $81.28 | $81.28 | $125.89 |
- 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
- $190.55 / $190.55 / $288.40
| Professional | | $190.55 | $190.55 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $223.87 / $1,122.02
| Facility | | $194.98 | $223.87 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $165.96 / $223.87
| Professional | | $85.11 | $165.96 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $114.82 / $245.47
| Facility | | $0.14 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $117.49 / $190.55
| Professional | | $83.18 | $117.49 | $190.55 |