- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.91 / $388.91 / $388.91
| Facility | | $388.91 | $388.91 | $388.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.43 / $327.43 / $390.48
| Professional | | $327.43 | $327.43 | $390.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.50 / $32.00 / $48.01
| Professional | | $13.50 | $32.00 | $48.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $310.31 / $310.31
| Professional | | $310.31 | $310.31 | $310.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.26 / $638.07 / $801.00
| Professional | | $283.26 | $638.07 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $85.00
| Professional | | $60.00 | $60.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.43 / $376.30 / $509.47
| Facility | | $327.43 | $376.30 | $509.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $310.31 / $310.31
| Professional | | $310.31 | $310.31 | $310.31 |