- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.98 / $67.27 / $175.09
| Facility | | $66.98 | $67.27 | $175.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $67.95
| Professional | | $67.27 | $67.27 | $67.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.43 / $67.27 / $8,639.91
| Facility | | $57.43 | $67.27 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $67.27
| Professional | | $67.27 | $67.27 | $67.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $67.27
| Facility | | $67.27 | $67.27 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $69.81
| Professional | | $67.27 | $67.27 | $69.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.64 / $69.81 / $116.36
| Professional | | $66.64 | $69.81 | $116.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.75 / $1,506.75 / $1,506.75
| Facility | | $1,506.75 | $1,506.75 | $1,506.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.98 / $67.27 / $175.09
| Facility | | $66.98 | $67.27 | $175.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $67.95
| Professional | | $67.27 | $67.27 | $67.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.00 / $467.00 / $467.00
| Professional | | $467.00 | $467.00 | $467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.47 / $67.27 / $67.27
| Facility | | $63.47 | $67.27 | $67.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $76.16
| Professional | | $67.27 | $67.27 | $76.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.92 / $29.92 / $29.92
| Facility | | $29.92 | $29.92 | $29.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.92 / $29.92 / $30.52
| Professional | | $29.92 | $29.92 | $30.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $123.10
| Professional | | $67.27 | $67.27 | $123.10 |