- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.49 / $222.49 / $239.75
| Facility | | $222.49 | $222.49 | $239.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $99.74 / $130.72
| Professional | | $95.90 | $99.74 | $130.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.29 / $106.61 / $303.91
| Facility | | $85.29 | $106.61 | $303.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $95.90 / $99.51
| Professional | | $95.90 | $95.90 | $99.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.90 / $95.90 / $280.50
| Facility | | $95.90 | $95.90 | $280.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $95.90 / $95.90
| Professional | | $95.90 | $95.90 | $95.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $95.90 / $95.90
| Professional | | $95.90 | $95.90 | $95.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.49 / $222.49 / $239.75
| Facility | | $222.49 | $222.49 | $239.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $109.11 / $181.49
| Professional | | $95.90 | $109.11 | $181.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $95.90 / $143.85
| Professional | | $95.90 | $95.90 | $143.85 |