- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.82 / $99.97 / $146.74
| Facility | | $99.82 | $99.97 | $146.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.82 / $99.97 / $120.78
| Professional | | $99.82 | $99.97 | $120.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.97 / $162.75 / $366.89
| Facility | | $99.97 | $162.75 | $366.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.97 / $99.97 / $99.97
| Professional | | $99.97 | $99.97 | $99.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.97 / $99.97 / $195.94
| Facility | | $99.97 | $99.97 | $195.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.31 / $94.31 / $99.97
| Facility | | $94.31 | $94.31 | $99.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.97 / $99.97 / $99.97
| Professional | | $99.97 | $99.97 | $99.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.35 / $336.00 / $399.00
| Professional | | $98.35 | $336.00 | $399.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.97 / $99.97 / $117.42
| Professional | | $99.97 | $99.97 | $117.42 |