- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.89 / $50.89 / $50.89
| Facility | | $50.89 | $50.89 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.89 / $61.07 / $108.50
| Professional | | $50.89 | $61.07 | $108.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.25 / $202.92 / $370.47
| Facility | | $61.25 | $202.92 | $370.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.42 / $72.92 / $91.15
| Professional | | $43.42 | $72.92 | $91.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.81 / $137.02 / $189.74
| Facility | | $117.81 | $137.02 | $189.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.34 / $113.03 / $156.47
| Professional | | $75.34 | $113.03 | $156.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.97 / $84.97 / $87.14
| Facility | | $84.97 | $84.97 | $87.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.03 / $84.97 / $87.38
| Professional | | $62.03 | $84.97 | $87.38 |
- 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
- $94.30 / $94.30 / $99.02
| Professional | | $94.30 | $94.30 | $99.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.42 / $54.42 / $60.75
| Facility | | $54.42 | $54.42 | $60.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.42 / $54.42 / $72.92
| Professional | | $54.42 | $54.42 | $72.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.51 / $370.47 / $370.47
| Facility | | $160.51 | $370.47 | $370.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.42 / $59.25 / $92.62
| Professional | | $43.42 | $59.25 | $92.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.42 / $60.79 / $102.24
| Professional | | $43.42 | $60.79 | $102.24 |