- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.75 / $151.93 / $191.59
| Facility | | $150.75 | $151.93 | $191.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.03 / $156.65 / $206.46
| Professional | | $124.03 | $156.65 | $206.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.68 / $326.83 / $540.78
| Facility | | $275.68 | $326.83 | $540.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.75 / $157.80 / $222.35
| Professional | | $152.75 | $157.80 | $222.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.78 / $190.78 / $190.78
| Facility | | $190.78 | $190.78 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.27 / $190.78 / $203.38
| Professional | | $139.27 | $190.78 | $203.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.45 / $137.54 / $215.34
| Professional | | $108.45 | $137.54 | $215.34 |