- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.43 / $182.95 / $192.10
| Facility | | $140.43 | $182.95 | $192.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $145.22 / $182.95
| Professional | | $140.99 | $145.22 | $182.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.99 / $239.68 / $506.44
| Facility | | $140.99 | $239.68 | $506.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $176.24
| Professional | | $140.99 | $140.99 | $176.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.01 / $133.01 / $140.99
| Facility | | $133.01 | $133.01 | $140.99 |
- 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 / $165.94 / $671.30
| Facility | | $140.43 | $165.94 | $671.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.09 / $140.43 / $167.11
| Professional | | $127.09 | $140.43 | $167.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.99 / $140.99 / $180.73
| Professional | | $140.99 | $140.99 | $180.73 |