- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $144.54 / $1,047.13
| Facility | | $54.95 | $144.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $147.91
| Professional | | $52.48 | $52.48 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $83.18 / $151.36
| Facility | | $61.66 | $83.18 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Professional | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $512.86
| Facility | | $512.86 | $512.86 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $52.48 / $56.23
| Professional | | $47.86 | $52.48 | $56.23 |