- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.99 / $176.79 / $628.91
| Facility | | $135.99 | $176.79 | $628.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.97 / $155.22 / $199.56
| Professional | | $76.97 | $155.22 | $199.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.86 / $253.01 / $420.21
| Facility | | $157.86 | $253.01 | $420.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.30 / $202.79 / $253.41
| Professional | | $92.30 | $202.79 | $253.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $128.29
| Facility | | $40.00 | $40.00 | $128.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.35 / $355.30 / $791.74
| Facility | | $134.35 | $355.30 | $791.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.03 / $109.82 / $276.58
| Professional | | $60.03 | $109.82 | $276.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.88 / $76.97 / $226.95
| Professional | | $53.88 | $76.97 | $226.95 |