- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.56 / $48.56 / $48.56
| Facility | | $48.56 | $48.56 | $48.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.42 / $47.42 / $48.56
| Professional | | $39.42 | $47.42 | $48.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.28 / $48.56 / $53.42
| Facility | | $41.28 | $48.56 | $53.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.56 / $48.56 / $48.56
| Professional | | $48.56 | $48.56 | $48.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.22 / $1,338.75 / $1,338.75
| Professional | | $147.22 | $1,338.75 | $1,338.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,165.00 / $3,243.00 / $13,785.00
| Facility | | $1,165.00 | $3,243.00 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.56 / $48.56 / $147.22
| Professional | | $48.56 | $48.56 | $147.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.58 / $207.58 / $207.58
| Facility | | $207.58 | $207.58 | $207.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.13 / $57.13 / $60.27
| Professional | | $57.13 | $57.13 | $60.27 |