- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $389.05
| Facility | | $186.21 | $218.78 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $239.88
| Professional | | $186.21 | $186.21 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $239.88 / $239.88
| Facility | | $229.09 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $204.17 / $204.17
| Professional | | $177.83 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $269.15
| Facility | | $141.25 | $190.55 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $208.93 / $213.80
| Professional | | $190.55 | $208.93 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $218.78
| Professional | | $181.97 | $213.80 | $218.78 |