- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.77 / $37.77 / $37.77
| Facility | | $37.77 | $37.77 | $37.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.77 / $41.63 / $61.90
| Professional | | $37.77 | $41.63 | $61.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.25 / $243.93 / $547.49
| Facility | | $68.25 | $243.93 | $547.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.94 / $65.81 / $84.42
| Professional | | $38.94 | $65.81 | $84.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.74 / $111.62 / $143.74
| Facility | | $91.74 | $111.62 | $143.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.60 / $71.98 / $71.98
| Professional | | $56.60 | $71.98 | $71.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $54.02 / $60.60
| Facility | | $50.00 | $54.02 | $60.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.43 / $39.43 / $133.50
| Professional | | $39.43 | $39.43 | $133.50 |
- 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
- $70.00 / $70.00 / $73.50
| Professional | | $70.00 | $70.00 | $73.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.93 / $54.93 / $54.93
| Professional | | $54.93 | $54.93 | $54.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.58 / $547.49 / $547.49
| Facility | | $281.58 | $547.49 | $547.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.22 / $45.38 / $84.42
| Professional | | $33.22 | $45.38 | $84.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.26 / $115.26 / $115.26
| Facility | | $115.26 | $115.26 | $115.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.94 / $43.13 / $84.42
| Professional | | $35.94 | $43.13 | $84.42 |