- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.55 / $41.55 / $41.55
| Facility | | $41.55 | $41.55 | $41.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.55 / $46.22 / $58.86
| Professional | | $41.55 | $46.22 | $58.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $222.45 / $553.99
| Facility | | $55.00 | $222.45 | $553.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $68.06 / $92.86
| Professional | | $39.61 | $68.06 | $92.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.93 / $122.79 / $158.13
| Facility | | $100.93 | $122.79 | $158.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.27 / $78.78 / $78.78
| Professional | | $62.27 | $78.78 | $78.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.01 / $62.81 / $66.67
| Facility | | $55.01 | $62.81 | $66.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $62.81 / $127.13
| Professional | | $45.85 | $62.81 | $127.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.00 / $77.00 / $80.84
| Professional | | $77.00 | $77.00 | $80.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.46 / $59.46 / $59.46
| Facility | | $59.46 | $59.46 | $59.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.46 / $59.46 / $59.46
| Professional | | $59.46 | $59.46 | $59.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.45 / $553.99 / $553.99
| Facility | | $222.45 | $553.99 | $553.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.20 / $47.44 / $92.86
| Professional | | $36.20 | $47.44 | $92.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.99 / $50.83 / $91.58
| Professional | | $36.99 | $50.83 | $91.58 |