- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.17 / $57.17 / $57.17
| Facility | | $57.17 | $57.17 | $57.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.41 / $23.42 / $27.82
| Professional | | $16.41 | $23.42 | $27.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.72 / $96.72 / $96.72
| Facility | | $96.72 | $96.72 | $96.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.41 / $28.36 / $166.58
| Professional | | $17.41 | $28.36 | $166.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.41 / $49.41 / $49.41
| Facility | | $49.41 | $49.41 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.04 / $19.04 / $25.92
| Professional | | $19.04 | $19.04 | $25.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $23.64 / $48.04
| Professional | | $12.28 | $23.64 | $48.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.40 / $29.40 / $34.59
| Professional | | $29.40 | $29.40 | $34.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.26 / $38.29 / $51.64
| Professional | | $20.26 | $38.29 | $51.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $19.00 / $22.39
| Professional | | $19.00 | $19.00 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.72 / $96.72 / $96.72
| Facility | | $96.72 | $96.72 | $96.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $28.31 / $166.58
| Professional | | $16.98 | $28.31 | $166.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.87 / $20.89 / $20.89
| Facility | | $17.87 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.66 / $25.06 / $30.39
| Professional | | $19.66 | $25.06 | $30.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.26 / $20.26 / $20.26
| Facility | | $20.26 | $20.26 | $20.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $21.63 / $44.98
| Professional | | $16.98 | $21.63 | $44.98 |