- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Facility | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $57.54 / $104.71
| Professional | | $42.66 | $57.54 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $134.90 / $501.19
| Facility | | $102.33 | $134.90 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $93.33 / $134.90
| Professional | | $48.98 | $93.33 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $229.09
| Facility | | $75.86 | $75.86 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $89.13 / $89.13
| Professional | | $85.11 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $75.86 / $91.20
| Facility | | $61.66 | $75.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $63.10
| Professional | | $44.67 | $44.67 | $63.10 |
- 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
- $114.82 / $114.82 / $173.78
| Professional | | $114.82 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $74.13
| Professional | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $134.90 / $501.19
| Facility | | $102.33 | $134.90 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $100.00 / $134.90
| Professional | | $48.98 | $100.00 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.08 / $54.95 / $134.90
| Facility | | $0.08 | $54.95 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $70.79 / $114.82
| Professional | | $45.71 | $70.79 | $114.82 |