- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $158.49
| Facility | | $83.18 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $58.88 / $177.83
| Professional | | $28.84 | $58.88 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $363.08
| Professional | | $32.36 | $60.26 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $45.71 / $50.12
| Facility | | $39.81 | $45.71 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $70.79 / $141.25
| Professional | | $39.81 | $70.79 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $41.69 / $91.20
| Professional | | $18.62 | $41.69 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $77.62 / $114.82
| Professional | | $58.88 | $77.62 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $70.79 / $138.04
| Professional | | $36.31 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $102.33 / $275.42
| Professional | | $56.23 | $102.33 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $61.66 / $363.08
| Professional | | $33.88 | $61.66 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $60.26 / $83.18
| Facility | | $31.62 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $56.23 / $123.03
| Professional | | $29.51 | $56.23 | $123.03 |