- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.75 / $98.52 / $161.50
| Facility | | $80.75 | $98.52 | $161.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $97.71
| Professional | | $80.91 | $80.91 | $97.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.73 / $64.73 / $80.91
| Facility | | $64.73 | $64.73 | $80.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.04 / $80.91 / $80.91
| Professional | | $75.04 | $80.91 | $80.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.33 / $76.33 / $80.91
| Facility | | $76.33 | $76.33 | $80.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $80.91
| Professional | | $80.91 | $80.91 | $80.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.33 / $114.50 / $332.00
| Facility | | $76.33 | $114.50 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.48 / $77.48 / $104.57
| Professional | | $77.48 | $77.48 | $104.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $82.44
| Facility | | $80.91 | $80.91 | $82.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $82.44
| Professional | | $80.91 | $80.91 | $82.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.33 / $76.33 / $597.00
| Facility | | $76.33 | $76.33 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $110.23
| Professional | | $80.91 | $80.91 | $110.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $109.22
| Professional | | $80.91 | $80.91 | $109.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.44 / $82.44 / $82.44
| Facility | | $82.44 | $82.44 | $82.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.91 / $80.91 / $82.44
| Professional | | $80.91 | $80.91 | $82.44 |