- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.88 / $248.88 / $249.29
| Facility | | $248.88 | $248.88 | $249.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.18 / $192.80 / $470.74
| Professional | | $145.18 | $192.80 | $470.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.71 / $208.09 / $310.05
| Professional | | $149.71 | $208.09 | $310.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.27 / $188.27 / $188.27
| Facility | | $188.27 | $188.27 | $188.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.12 / $228.96 / $399.05
| Professional | | $161.12 | $228.96 | $399.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.61 / $201.36 / $339.88
| Professional | | $156.61 | $201.36 | $339.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.91 / $201.51 / $310.69
| Professional | | $160.91 | $201.51 | $310.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.97 / $212.75 / $239.53
| Professional | | $192.97 | $212.75 | $239.53 |