- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $70.79 / $87.10
| Professional | | $63.10 | $70.79 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $117.49 / $234.42
| Professional | | $74.13 | $117.49 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $354.81 / $562.34
| Facility | | $302.00 | $354.81 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $134.90 / $204.17
| Professional | | $93.33 | $134.90 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $83.18 / $138.04
| Facility | | $66.07 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $204.17 / $309.03
| Professional | | $120.23 | $204.17 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $87.10 / $138.04
| Facility | | $69.18 | $87.10 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $645.65
| Professional | | $91.20 | $158.49 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $512.86
| Facility | | $213.80 | $213.80 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $478.63 / $616.60
| Professional | | $102.33 | $478.63 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Professional | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $234.42
| Professional | | $131.83 | $169.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $128.82 / $213.80
| Professional | | $87.10 | $128.82 | $213.80 |