- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.99 / $280.86 / $574.55
| Facility | | $140.99 | $280.86 | $574.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $148.85 / $169.92
| Professional | | $140.99 | $148.85 | $169.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.68 / $247.55 / $451.17
| Facility | | $153.68 | $247.55 | $451.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.01 / $133.01 / $199.51
| Facility | | $133.01 | $133.01 | $199.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.43 / $167.41 / $233.88
| Facility | | $140.43 | $167.41 | $233.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.74 / $155.09 / $231.22
| Professional | | $105.74 | $155.09 | $231.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $140.99
| Professional | | $140.99 | $140.99 | $140.99 |