- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.11 / $43.11 / $43.11
| Facility | | $43.11 | $43.11 | $43.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.11 / $43.97 / $82.63
| Professional | | $43.11 | $43.97 | $82.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.00 / $198.78 / $571.00
| Facility | | $63.00 | $198.78 | $571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.98 / $71.14 / $96.35
| Professional | | $44.98 | $71.14 | $96.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.06 / $57.06 / $169.47
| Facility | | $57.06 | $57.06 | $169.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.59 / $87.54 / $87.54
| Professional | | $64.59 | $87.54 | $87.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.06 / $59.82 / $69.16
| Facility | | $57.06 | $59.82 | $69.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.67 / $59.82 / $107.25
| Professional | | $43.67 | $59.82 | $107.25 |
- 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
- $79.89 / $79.89 / $83.88
| Professional | | $79.89 | $79.89 | $83.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.46 / $62.46 / $62.46
| Professional | | $62.46 | $62.46 | $62.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.08 / $571.00 / $571.00
| Facility | | $199.08 | $571.00 | $571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $52.74 / $96.35
| Professional | | $38.54 | $52.74 | $96.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.21 / $120.21 / $120.21
| Facility | | $120.21 | $120.21 | $120.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.34 / $52.83 / $95.95
| Professional | | $42.34 | $52.83 | $95.95 |