- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.40 / $89.40 / $89.40
| Facility | | $89.40 | $89.40 | $89.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.30 / $94.89 / $247.08
| Professional | | $59.30 | $94.89 | $247.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.45 / $81.28 / $194.59
| Professional | | $65.45 | $81.28 | $194.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.75 / $140.75 / $140.75
| Facility | | $140.75 | $140.75 | $140.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.75 / $140.75 / $140.75
| Professional | | $140.75 | $140.75 | $140.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.03 / $106.03 / $106.03
| Facility | | $106.03 | $106.03 | $106.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $81.84 / $81.84
| Professional | | $81.84 | $81.84 | $81.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.42 / $93.42 / $214.77
| Facility | | $93.42 | $93.42 | $214.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.27 / $128.86 / $197.38
| Professional | | $102.27 | $128.86 | $197.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.51 / $96.76 / $184.88
| Professional | | $75.51 | $96.76 | $184.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.54 / $112.16 / $112.77
| Professional | | $111.54 | $112.16 | $112.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.03 / $106.03 / $597.00
| Facility | | $106.03 | $106.03 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.84 / $101.26 / $218.61
| Professional | | $81.84 | $101.26 | $218.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.37 / $111.03 / $268.49
| Professional | | $84.37 | $111.03 | $268.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.02 / $99.67 / $186.35
| Professional | | $77.02 | $99.67 | $186.35 |