- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.22 / $155.44 / $186.54
| Facility | | $149.22 | $155.44 | $186.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.22 / $149.22 / $186.54
| Professional | | $149.22 | $149.22 | $186.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.33 / $168.62 / $183.83
| Facility | | $143.33 | $168.62 | $183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.56 / $158.56 / $158.56
| Facility | | $158.56 | $158.56 | $158.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.56 / $158.56 / $158.56
| Professional | | $158.56 | $158.56 | $158.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.92 / $149.22 / $186.54
| Facility | | $48.92 | $149.22 | $186.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $155.44 / $162.36
| Professional | | $155.44 | $155.44 | $162.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $155.44 / $162.72
| Professional | | $155.44 | $155.44 | $162.72 |