- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.42 / $68.42 / $68.42
| Facility | | $68.42 | $68.42 | $68.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.42 / $68.42 / $93.43
| Professional | | $68.42 | $68.42 | $93.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.12 / $305.80 / $743.85
| Facility | | $147.12 | $305.80 | $743.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.72 / $118.85 / $152.93
| Professional | | $64.72 | $118.85 | $152.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.58 / $90.58 / $269.02
| Facility | | $90.58 | $90.58 | $269.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $138.94 / $138.94
| Professional | | $112.79 | $138.94 | $138.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.58 / $97.44 / $109.78
| Facility | | $90.58 | $97.44 | $109.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.13 / $97.44 / $174.75
| Professional | | $71.13 | $97.44 | $174.75 |
- 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
- $126.79 / $126.79 / $133.13
| Professional | | $126.79 | $126.79 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.37 / $102.37 / $102.37
| Professional | | $102.37 | $102.37 | $102.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.80 / $743.85 / $743.85
| Facility | | $305.80 | $743.85 | $743.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.60 / $83.70 / $152.93
| Professional | | $58.60 | $83.70 | $152.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.60 / $156.60 / $156.60
| Facility | | $156.60 | $156.60 | $156.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.62 / $83.70 / $126.79
| Professional | | $59.62 | $83.70 | $126.79 |