- 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 / $44.39 / $55.72
| Professional | | $41.55 | $44.39 | $55.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $268.33 / $560.79
| Facility | | $55.00 | $268.33 | $560.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.11 / $68.06 / $92.86
| Professional | | $40.11 | $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 / $60.55 / $66.67
| Facility | | $55.01 | $60.55 | $66.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.20 / $60.55 / $108.38
| Professional | | $44.20 | $60.55 | $108.38 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $60.57 / $60.57 / $60.57
| Professional | | $60.57 | $60.57 | $60.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.27 / $560.79 / $560.79
| Facility | | $298.27 | $560.79 | $560.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.20 / $47.44 / $92.86
| Professional | | $36.20 | $47.44 | $92.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.06 / $118.06 / $118.06
| Facility | | $118.06 | $118.06 | $118.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.14 / $50.83 / $88.55
| Professional | | $37.14 | $50.83 | $88.55 |