- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.75 / $91.66 / $219.98
| Facility | | $68.75 | $91.66 | $219.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.83 / $67.83 / $98.08
| Professional | | $67.83 | $67.83 | $98.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.58 / $59.58 / $244.87
| Facility | | $59.58 | $59.58 | $244.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.63 / $111.63 / $133.75
| Professional | | $111.63 | $111.63 | $133.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.83 / $91.66 / $153.99
| Facility | | $67.83 | $91.66 | $153.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.50 / $47.53 / $137.49
| Professional | | $38.50 | $47.53 | $137.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.50 / $47.53 / $67.90
| Professional | | $38.50 | $47.53 | $67.90 |