- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.97 / $83.97 / $83.97
| Facility | | $83.97 | $83.97 | $83.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.38 / $83.97 / $112.50
| Professional | | $70.38 | $83.97 | $112.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.66 / $292.60 / $870.20
| Facility | | $116.66 | $292.60 | $870.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $116.99 / $187.68
| Professional | | $75.06 | $116.99 | $187.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.16 / $111.16 / $330.15
| Facility | | $111.16 | $111.16 | $330.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $170.53 / $170.53
| Professional | | $138.41 | $170.53 | $170.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.07 / $111.16 / $134.72
| Facility | | $90.07 | $111.16 | $134.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.75 / $90.07 / $167.25
| Professional | | $65.75 | $90.07 | $167.25 |
- 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
- $155.61 / $155.61 / $163.38
| Professional | | $155.61 | $155.61 | $163.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.58 / $91.58 / $91.58
| Professional | | $91.58 | $91.58 | $91.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.60 / $870.20 / $870.20
| Facility | | $292.60 | $870.20 | $870.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.91 / $102.73 / $187.68
| Professional | | $71.91 | $102.73 | $187.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.17 / $102.73 / $170.83
| Professional | | $73.17 | $102.73 | $170.83 |