- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.80 / $78.80 / $78.80
| Facility | | $78.80 | $78.80 | $78.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.80 / $82.52 / $98.86
| Professional | | $78.80 | $82.52 | $98.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.29 / $80.29 / $80.29
| Facility | | $80.29 | $80.29 | $80.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.54 / $82.54 / $103.17
| Professional | | $82.54 | $82.54 | $103.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.74 / $116.83 / $223.86
| Facility | | $58.74 | $116.83 | $223.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.80 / $91.50 / $91.50
| Professional | | $78.80 | $91.50 | $91.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.53 / $98.04 / $142.50
| Facility | | $39.53 | $98.04 | $142.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.21 / $92.83 / $122.15
| Professional | | $38.21 | $92.83 | $122.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.22 / $86.22 / $86.22
| Professional | | $86.22 | $86.22 | $86.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.98 / $78.80 / $88.26
| Professional | | $66.98 | $78.80 | $88.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.70 / $81.70 / $81.70
| Facility | | $81.70 | $81.70 | $81.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.70 / $81.70 / $81.70
| Professional | | $81.70 | $81.70 | $81.70 |