- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.73 / $54.73 / $54.73
| Facility | | $54.73 | $54.73 | $54.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.68 / $54.73 / $77.17
| Professional | | $46.68 | $54.73 | $77.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.71 / $91.40 / $235.37
| Professional | | $57.71 | $91.40 | $235.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.97 / $68.97 / $68.97
| Facility | | $68.97 | $68.97 | $68.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.86 / $268.39 / $305.00
| Professional | | $50.86 | $268.39 | $305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $54.73 / $131.35
| Facility | | $46.68 | $54.73 | $131.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $54.73 / $131.35
| Facility | | $46.68 | $54.73 | $131.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.55 / $60.55 / $368.87
| Professional | | $60.55 | $60.55 | $368.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $65.00 / $190.90
| Professional | | $50.00 | $65.00 | $190.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $54.73 / $128.69
| Facility | | $46.68 | $54.73 | $128.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.51 / $145.93 / $203.50
| Professional | | $79.51 | $145.93 | $203.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.97 / $327.45 / $327.45
| Facility | | $68.97 | $327.45 | $327.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.86 / $275.70 / $368.87
| Professional | | $50.86 | $275.70 | $368.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.31 / $67.31 / $71.28
| Professional | | $67.31 | $67.31 | $71.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.55 / $60.55 / $76.29
| Professional | | $60.55 | $60.55 | $76.29 |