- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.71 / $51.71 / $51.71
| Facility | | $51.71 | $51.71 | $51.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.71 / $51.71 / $81.95
| Professional | | $51.71 | $51.71 | $81.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.50 / $220.78 / $589.04
| Facility | | $73.50 | $220.78 | $589.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.24 / $80.50 / $115.59
| Professional | | $46.24 | $80.50 | $115.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.47 / $68.47 / $203.36
| Facility | | $68.47 | $68.47 | $203.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.72 / $68.47 / $82.97
| Facility | | $66.72 | $68.47 | $82.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.71 / $66.72 / $118.13
| Professional | | $48.71 | $66.72 | $118.13 |
- 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
- $95.83 / $95.83 / $100.62
| Professional | | $95.83 | $95.83 | $100.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.72 / $67.72 / $67.72
| Professional | | $67.72 | $67.72 | $67.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.74 / $589.04 / $589.04
| Facility | | $206.74 | $589.04 | $589.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.30 / $59.05 / $115.59
| Professional | | $42.30 | $59.05 | $115.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.98 / $61.98 / $61.98
| Facility | | $61.98 | $61.98 | $61.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.88 / $63.26 / $115.59
| Professional | | $45.88 | $63.26 | $115.59 |