- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Facility | | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $67.61
| Professional | | $43.65 | $51.29 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $69.18 / $75.86
| Professional | | $69.18 | $69.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Professional | | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $44.67 / $61.66
| Facility | | $44.67 | $44.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $44.67 / $67.61
| Professional | | $38.02 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $74.13 / $102.33
| Professional | | $64.57 | $74.13 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $120.23
| Professional | | $45.71 | $45.71 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $50.12 / $93.33
| Facility | | $25.12 | $50.12 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.50 / $12.88 / $77.62
| Facility | | $5.50 | $12.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $14.79 / $77.62
| Professional | | $5.50 | $14.79 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $26.30 / $52.48
| Facility | | $3.31 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $45.71 / $70.79
| Professional | | $33.88 | $45.71 | $70.79 |