- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.50 / $60.50 / $64.81
| Facility | | $60.50 | $60.50 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.50 / $60.50 / $60.50
| Professional | | $60.50 | $60.50 | $60.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.43 / $296.51 / $573.54
| Facility | | $225.43 | $296.51 | $573.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.34 / $145.74 / $150.31
| Professional | | $132.34 | $145.74 | $150.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.99 / $166.46 / $208.08
| Professional | | $109.99 | $166.46 | $208.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $169.74 / $435.39
| Facility | | $55.00 | $169.74 | $435.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $327.06
| Professional | | $55.00 | $55.00 | $327.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.99 / $188.82 / $219.64
| Facility | | $109.99 | $188.82 | $219.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.99 / $199.70 / $234.65
| Professional | | $109.99 | $199.70 | $234.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.24 / $107.24 / $186.99
| Professional | | $107.24 | $107.24 | $186.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.25 / $55.00 / $183.32
| Professional | | $52.25 | $55.00 | $183.32 |