- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $77.62 / $190.55
| Professional | | $57.54 | $77.62 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $141.25 / $870.96
| Facility | | $123.03 | $141.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $141.25
| Professional | | $63.10 | $107.15 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $245.47
| Facility | | $79.43 | $79.43 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $114.82 / $114.82
| Professional | | $91.20 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $87.10 / $97.72
| Facility | | $79.43 | $87.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $89.13
| Professional | | $63.10 | $63.10 | $89.13 |
- 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
- $120.23 / $120.23 / $186.21
| Professional | | $120.23 | $120.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $141.25 / $870.96
| Facility | | $123.03 | $141.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $107.15 / $141.25
| Professional | | $63.10 | $107.15 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.11 / $83.18 / $190.55
| Facility | | $0.11 | $83.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $83.18 / $120.23
| Professional | | $57.54 | $83.18 | $120.23 |