- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Facility | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $67.61 / $147.91
| Professional | | $56.23 | $67.61 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $776.25
| Facility | | $131.83 | $151.36 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $107.15 / $151.36
| Professional | | $61.66 | $107.15 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $263.03
| Facility | | $85.11 | $85.11 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $131.83 / $131.83
| Professional | | $107.15 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $89.13 / $104.71
| Facility | | $85.11 | $89.13 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $89.13
| Professional | | $64.57 | $64.57 | $89.13 |
- 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
- $128.82 / $128.82 / $199.53
| Professional | | $128.82 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $776.25
| Facility | | $131.83 | $151.36 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $112.20 / $165.96
| Professional | | $61.66 | $112.20 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $91.20 / $165.96
| Facility | | $0.10 | $91.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $91.20 / $128.82
| Professional | | $60.26 | $91.20 | $128.82 |