- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $89.13 / $181.97
| Professional | | $67.61 | $89.13 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $181.97 / $794.33
| Facility | | $158.49 | $181.97 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $125.89 / $181.97
| Professional | | $69.18 | $125.89 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $309.03
| Facility | | $102.33 | $102.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $134.90 / $134.90
| Professional | | $125.89 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $131.83
| Facility | | $102.33 | $128.82 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $131.83
| Professional | | $97.72 | $97.72 | $131.83 |
- 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
- $154.88 / $154.88 / $234.42
| Professional | | $154.88 | $154.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $181.97 / $794.33
| Facility | | $158.49 | $181.97 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $134.90 / $181.97
| Professional | | $69.18 | $134.90 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.12 / $83.18 / $204.17
| Facility | | $0.12 | $83.18 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $95.50 / $154.88
| Professional | | $69.18 | $95.50 | $154.88 |