- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.82 / $111.80 / $199.64
| Facility | | $99.82 | $111.80 | $199.64 |
- 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
- $117.88 / $169.95 / $436.94
| Facility | | $117.88 | $169.95 | $436.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.82 / $99.97 / $99.97
| Professional | | $99.82 | $99.97 | $99.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.31 / $99.97 / $99.97
| Facility | | $94.31 | $99.97 | $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
- $104.89 / $162.35 / $308.56
| Professional | | $104.89 | $162.35 | $308.56 |
- 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
- $99.81 / $109.79 / $139.72
| Professional | | $99.81 | $109.79 | $139.72 |