- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.41 / $49.41 / $49.41
| Facility | | $49.41 | $49.41 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.41 / $54.47 / $72.38
| Professional | | $49.41 | $54.47 | $72.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.06 / $151.63 / $539.41
| Facility | | $48.06 | $151.63 | $539.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.06 / $81.87 / $110.46
| Professional | | $48.06 | $81.87 | $110.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.45 / $50.45 / $149.84
| Facility | | $50.45 | $50.45 | $149.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.17 / $73.17 / $77.89
| Professional | | $73.17 | $73.17 | $77.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.70 / $70.70 / $70.70
| Facility | | $70.70 | $70.70 | $70.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.62 / $70.70 / $134.25
| Professional | | $51.62 | $70.70 | $134.25 |
- 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
- $91.57 / $91.57 / $96.15
| Professional | | $91.57 | $91.57 | $96.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.59 / $65.59 / $65.59
| Professional | | $65.59 | $65.59 | $65.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $539.41 / $539.41
| Facility | | $100.00 | $539.41 | $539.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.02 / $56.69 / $110.46
| Professional | | $43.02 | $56.69 | $110.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.18 / $60.64 / $110.46
| Professional | | $44.18 | $60.64 | $110.46 |