- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $354.81
| Facility | | $57.54 | $57.54 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $69.18 / $117.49
| Professional | | $52.48 | $69.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $138.04 / $630.96
| Facility | | $120.23 | $138.04 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $95.50 / $138.04
| Professional | | $53.70 | $95.50 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $234.42
| Facility | | $77.62 | $77.62 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $102.33 / $102.33
| Professional | | $87.10 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $91.20 / $93.33
| Facility | | $77.62 | $91.20 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $91.20
| Professional | | $67.61 | $67.61 | $91.20 |
- 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
- $117.49 / $117.49 / $177.83
| Professional | | $117.49 | $117.49 | $177.83 |
- 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
- $120.23 / $138.04 / $630.96
| Facility | | $120.23 | $138.04 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $102.33 / $138.04
| Professional | | $53.70 | $102.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.09 / $66.07 / $154.88
| Facility | | $0.09 | $66.07 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $74.13 / $117.49
| Professional | | $52.48 | $74.13 | $117.49 |