- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.08 / $124.08 / $124.08
| Facility | | $124.08 | $124.08 | $124.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.36 / $22.55 / $35.61
| Professional | | $20.36 | $22.55 | $35.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.86 / $208.86 / $208.86
| Facility | | $208.86 | $208.86 | $208.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.47 / $43.97 / $219.85
| Professional | | $18.47 | $43.97 | $219.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.36 / $87.36 / $87.36
| Facility | | $87.36 | $87.36 | $87.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.34 / $41.33 / $43.53
| Professional | | $27.34 | $41.33 | $43.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.12 / $23.12 / $48.50
| Professional | | $23.12 | $23.12 | $48.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.47 / $63.47 / $74.67
| Professional | | $63.47 | $63.47 | $74.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.97 / $86.80 / $112.08
| Professional | | $43.97 | $86.80 | $112.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.86 / $208.86 / $208.86
| Facility | | $208.86 | $208.86 | $208.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.38 / $219.85
| Professional | | $18.23 | $26.38 | $219.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.97 / $43.97 / $43.97
| Facility | | $43.97 | $43.97 | $43.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.38 / $83.81
| Professional | | $18.23 | $26.38 | $83.81 |