- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.32 / $57.32 / $57.32
| Facility | | $57.32 | $57.32 | $57.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.20 / $57.32 / $73.86
| Professional | | $55.20 | $57.32 | $73.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.43 / $256.61 / $503.80
| Facility | | $85.43 | $256.61 | $503.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.06 / $85.43 / $128.10
| Professional | | $48.06 | $85.43 | $128.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.88 / $75.88 / $225.36
| Facility | | $75.88 | $75.88 | $225.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.90 / $88.71 / $88.71
| Professional | | $85.90 | $88.71 | $88.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.48 / $75.88 / $91.96
| Facility | | $61.48 | $75.88 | $91.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.88 / $61.48 / $119.25
| Professional | | $44.88 | $61.48 | $119.25 |
- 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
- $106.22 / $106.22 / $111.53
| Professional | | $106.22 | $106.22 | $111.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.22 / $74.22 / $74.22
| Professional | | $74.22 | $74.22 | $74.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.62 / $503.80 / $503.80
| Facility | | $208.62 | $503.80 | $503.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.63 / $65.45 / $128.10
| Professional | | $43.63 | $65.45 | $128.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.60 / $29.60 / $29.60
| Facility | | $29.60 | $29.60 | $29.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.63 / $65.45 / $106.22
| Professional | | $43.63 | $65.45 | $106.22 |