- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.40 / $62.40 / $62.40
| Facility | | $62.40 | $62.40 | $62.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.40 / $68.79 / $91.50
| Professional | | $62.40 | $68.79 | $91.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.18 / $403.05 / $681.55
| Facility | | $134.18 | $403.05 | $681.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.22 / $108.39 / $145.06
| Professional | | $59.22 | $108.39 | $145.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.56 / $159.56 / $473.89
| Facility | | $159.56 | $159.56 | $473.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.52 / $118.92 / $118.92
| Professional | | $93.52 | $118.92 | $118.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.70 / $100.13 / $159.56
| Facility | | $81.70 | $100.13 | $159.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.64 / $81.70 / $169.50
| Professional | | $59.64 | $81.70 | $169.50 |
- 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
- $115.64 / $115.64 / $121.42
| Professional | | $115.64 | $115.64 | $121.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.70 / $85.70 / $85.70
| Professional | | $85.70 | $85.70 | $85.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.13 / $681.55 / $681.55
| Facility | | $297.13 | $681.55 | $681.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.36 / $71.26 / $139.47
| Professional | | $54.36 | $71.26 | $139.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.28 / $76.34 / $139.47
| Professional | | $55.28 | $76.34 | $139.47 |