- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $79.43 / $234.42
| Professional | | $53.70 | $79.43 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $181.97 / $831.76
| Facility | | $158.49 | $181.97 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $131.83 / $181.97
| Professional | | $66.07 | $131.83 | $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
- $114.82 / $144.54 / $144.54
| Professional | | $114.82 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $107.15 / $123.03
| Facility | | $102.33 | $107.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $107.15
| Professional | | $77.62 | $77.62 | $107.15 |
- 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
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $181.97 / $831.76
| Facility | | $158.49 | $181.97 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $134.90 / $181.97
| Professional | | $66.07 | $134.90 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.11 / $85.11 / $181.97
| Facility | | $0.11 | $85.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $95.50 / $154.88
| Professional | | $64.57 | $95.50 | $154.88 |