- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.99 / $135.99 / $141.15
| Facility | | $135.99 | $135.99 | $141.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.65 / $121.91 / $163.91
| Professional | | $97.65 | $121.91 | $163.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.95 / $218.84 / $238.96
| Facility | | $204.95 | $218.84 | $238.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.09 / $161.11 / $161.11
| Professional | | $127.09 | $161.11 | $161.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.41 / $134.41 / $134.41
| Facility | | $134.41 | $134.41 | $134.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.26 / $134.41 / $241.83
| Professional | | $114.26 | $134.41 | $241.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.70 / $101.90 / $153.50
| Professional | | $72.70 | $101.90 | $153.50 |