- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.62 / $56.62 / $56.62
| Facility | | $56.62 | $56.62 | $56.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.11 / $56.62 / $72.95
| Professional | | $54.11 | $56.62 | $72.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.06 / $243.52 / $615.54
| Facility | | $81.06 | $243.52 | $615.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.47 / $81.06 / $126.55
| Professional | | $47.47 | $81.06 | $126.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.95 / $74.95 / $222.60
| Facility | | $74.95 | $74.95 | $222.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.85 / $107.35 / $107.35
| Professional | | $84.85 | $107.35 | $107.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.27 / $74.95 / $90.84
| Facility | | $73.27 | $74.95 | $90.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.49 / $73.27 / $121.88
| Professional | | $53.49 | $73.27 | $121.88 |
- 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
- $104.92 / $104.92 / $110.17
| Professional | | $104.92 | $104.92 | $110.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.08 / $63.08 / $63.08
| Professional | | $63.08 | $63.08 | $63.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.72 / $615.54 / $615.54
| Facility | | $213.72 | $615.54 | $615.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.10 / $64.65 / $126.55
| Professional | | $43.10 | $64.65 | $126.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.10 / $64.65 / $104.92
| Professional | | $43.10 | $64.65 | $104.92 |