- 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
- $56.23 / $72.44 / $128.82
| Professional | | $56.23 | $72.44 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $707.95
| Facility | | $109.65 | $141.25 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $102.33 / $141.25
| Professional | | $57.54 | $102.33 | $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 / $93.33 / $97.72
| Facility | | $79.43 | $93.33 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $93.33
| Professional | | $67.61 | $67.61 | $93.33 |
- 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
- $72.44 / $72.44 / $72.44
| Professional | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $707.95
| Facility | | $109.65 | $141.25 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $104.71 / $141.25
| Professional | | $57.54 | $104.71 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $74.13 / $173.78
| Facility | | $0.10 | $74.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $79.43 / $120.23
| Professional | | $53.70 | $79.43 | $120.23 |