- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $151.36 / $181.97
| Facility | | $131.83 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $151.36 / $177.83
| Professional | | $141.25 | $151.36 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $331.13
| Professional | | $138.04 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $162.18 / $275.42
| Professional | | $125.89 | $162.18 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $239.88
| Facility | | $151.36 | $151.36 | $239.88 |