- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $72.44
| Facility | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $85.11 / $169.82
| Professional | | $69.18 | $85.11 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $812.83
| Facility | | $151.36 | $173.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $128.82 / $173.78
| Professional | | $69.18 | $128.82 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $407.38
| Facility | | $134.90 | $134.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $141.25 / $141.25
| Professional | | $109.65 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $104.71 / $117.49
| Facility | | $58.88 | $104.71 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $104.71
| Professional | | $75.86 | $75.86 | $104.71 |
- 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
- $147.91 / $147.91 / $223.87
| Professional | | $147.91 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $173.78 / $812.83
| Facility | | $151.36 | $173.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $131.83 / $173.78
| Professional | | $69.18 | $131.83 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.12 / $97.72 / $208.93
| Facility | | $0.12 | $97.72 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $97.72 / $147.91
| Professional | | $66.07 | $97.72 | $147.91 |