- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $57.54 / $104.71
| Professional | | $47.86 | $57.54 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $114.82 / $562.34
| Facility | | $112.20 | $114.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $89.13 / $120.23
| Professional | | $47.86 | $89.13 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $204.17
| Facility | | $131.83 | $151.36 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $107.15 / $107.15
| Professional | | $87.10 | $107.15 | $107.15 |
- 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
- $54.95 / $54.95 / $75.86
| Professional | | $54.95 | $54.95 | $75.86 |
- 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
- $102.33 / $102.33 / $154.88
| Professional | | $102.33 | $102.33 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Professional | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $114.82 / $562.34
| Facility | | $112.20 | $114.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $91.20 / $131.83
| Professional | | $47.86 | $91.20 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.08 / $63.10 / $144.54
| Facility | | $0.08 | $63.10 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $66.07 / $102.33
| Professional | | $45.71 | $66.07 | $102.33 |