- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.79 / $74.79 / $242.68
| Facility | | $74.79 | $74.79 | $242.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.56 / $74.79 / $100.20
| Professional | | $66.56 | $74.79 | $100.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.98 / $154.34 / $304.89
| Facility | | $60.98 | $154.34 | $304.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.50 / $73.50 / $73.50
| Professional | | $73.50 | $73.50 | $73.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Facility | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.36 / $70.36 / $70.36
| Facility | | $70.36 | $70.36 | $70.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.36 / $70.36 / $70.36
| Professional | | $70.36 | $70.36 | $70.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $149.58 / $272.63
| Facility | | $80.00 | $149.58 | $272.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.34 / $73.04 / $96.10
| Professional | | $65.34 | $73.04 | $96.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.79 / $74.79 / $106.95
| Facility | | $74.79 | $74.79 | $106.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.00 / $120.00 / $120.00
| Professional | | $120.00 | $120.00 | $120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.53 / $70.36 / $106.95
| Facility | | $60.53 | $70.36 | $106.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.36 / $70.36 / $70.36
| Professional | | $70.36 | $70.36 | $70.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.52 / $75.17 / $76.58
| Professional | | $60.52 | $75.17 | $76.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.30 / $62.30 / $84.11
| Professional | | $62.30 | $62.30 | $84.11 |