- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $56.23 / $125.89
| Professional | | $40.74 | $56.23 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $616.60
| Facility | | $114.82 | $131.83 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $97.72 / $131.83
| Professional | | $50.12 | $97.72 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $223.87
| Facility | | $74.13 | $74.13 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $114.82 / $114.82
| Professional | | $93.33 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $74.13 / $89.13
| Facility | | $60.26 | $74.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $69.18
| Professional | | $43.65 | $43.65 | $69.18 |
- 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
- $112.20 / $112.20 / $169.82
| Professional | | $112.20 | $112.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $131.83 / $616.60
| Facility | | $114.82 | $131.83 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $97.72 / $144.54
| Professional | | $50.12 | $97.72 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.08 / $72.44 / $131.83
| Facility | | $0.08 | $72.44 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $72.44 / $112.20
| Professional | | $48.98 | $72.44 | $112.20 |