- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $93.33 / $120.23
| Professional | | $77.62 | $93.33 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $194.98
| Facility | | $104.71 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $123.03 / $144.54
| Professional | | $8.91 | $123.03 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $158.49
| Professional | | $112.20 | $112.20 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $89.13 / $89.13
| Facility | | $83.18 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $158.49
| Professional | | $89.13 | $89.13 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $112.20 / $112.20
| Professional | | $9.55 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $7.24 / $7.24
| Facility | | $7.24 | $7.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $95.50
| Professional | | $72.44 | $72.44 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $194.98
| Facility | | $104.71 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $109.65 / $144.54
| Professional | | $8.91 | $109.65 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $21.38 / $128.82
| Facility | | $7.76 | $21.38 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $91.20 / $128.82
| Professional | | $7.41 | $91.20 | $128.82 |