- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.42 / $436.81 / $469.49
| Facility | | $164.42 | $436.81 | $469.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.42 / $164.42 / $164.42
| Professional | | $164.42 | $164.42 | $164.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.42 / $247.86 / $492.85
| Facility | | $164.42 | $247.86 | $492.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.53 / $190.53 / $190.53
| Professional | | $190.53 | $190.53 | $190.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.62 / $219.62 / $219.62
| Facility | | $219.62 | $219.62 | $219.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.62 / $219.62 / $219.62
| Professional | | $219.62 | $219.62 | $219.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.64 / $211.64 / $211.64
| Facility | | $211.64 | $211.64 | $211.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.13 / $210.98 / $220.75
| Professional | | $183.13 | $210.98 | $220.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.42 / $164.42 / $216.35
| Professional | | $164.42 | $164.42 | $216.35 |