- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.45 / $105.33 / $174.85
| Facility | | $68.45 | $105.33 | $174.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.33 / $105.33 / $105.33
| Professional | | $105.33 | $105.33 | $105.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.44 / $194.44 / $194.44
| Facility | | $194.44 | $194.44 | $194.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.65 / $71.65 / $79.61
| Professional | | $71.65 | $71.65 | $79.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.50 / $71.62 / $72.69
| Facility | | $60.50 | $71.62 | $72.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.48 / $105.33 / $114.35
| Professional | | $91.48 | $105.33 | $114.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.59 / $105.33 / $105.33
| Facility | | $83.59 | $105.33 | $105.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.45 / $97.79 / $97.79
| Professional | | $68.45 | $97.79 | $97.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.48 / $51.33 / $100.06
| Professional | | $41.48 | $51.33 | $100.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.40 / $378.15 / $378.15
| Facility | | $126.40 | $378.15 | $378.15 |