- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.50 / $156.97 / $175.88
| Facility | | $149.50 | $156.97 | $175.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.50 / $156.97 / $172.67
| Professional | | $149.50 | $156.97 | $172.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.31 / $40.31 / $60.47
| Facility | | $40.31 | $40.31 | $60.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.50 / $172.37 / $172.37
| Facility | | $149.50 | $172.37 | $172.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.37 / $172.37 / $212.74
| Professional | | $172.37 | $172.37 | $212.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $149.63 / $153.90
| Professional | | $149.63 | $149.63 | $153.90 |