- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.76 / $55.76 / $55.76
| Facility | | $55.76 | $55.76 | $55.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $55.76 / $71.87
| Professional | | $36.61 | $55.76 | $71.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.77 / $272.66 / $606.29
| Facility | | $90.77 | $272.66 | $606.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.76 / $86.45 / $124.65
| Professional | | $46.76 | $86.45 | $124.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.47 / $164.82 / $212.25
| Facility | | $135.47 | $164.82 | $212.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.20 / $106.28 / $106.28
| Professional | | $75.20 | $106.28 | $106.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.81 / $73.81 / $89.47
| Facility | | $62.81 | $73.81 | $89.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $62.81 / $114.38
| Professional | | $45.85 | $62.81 | $114.38 |
- 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
- $103.34 / $103.34 / $108.51
| Professional | | $103.34 | $103.34 | $108.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.81 / $60.81 / $60.81
| Professional | | $60.81 | $60.81 | $60.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.44 / $606.29 / $606.29
| Facility | | $223.44 | $606.29 | $606.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.45 / $63.68 / $124.65
| Professional | | $42.45 | $63.68 | $124.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.45 / $63.68 / $107.55
| Professional | | $42.45 | $63.68 | $107.55 |