- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.24 / $167.24 / $337.89
| Facility | | $167.24 | $167.24 | $337.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.59 / $167.24 / $181.48
| Professional | | $160.59 | $167.24 | $181.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.93 / $302.41 / $337.89
| Facility | | $266.93 | $302.41 | $337.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.82 / $183.50 / $253.23
| Professional | | $164.82 | $183.50 | $253.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.42 / $371.68 / $473.05
| Facility | | $253.42 | $371.68 | $473.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.20 / $371.68 / $456.15
| Professional | | $287.20 | $371.68 | $456.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.57 / $218.57 / $337.89
| Facility | | $218.57 | $218.57 | $337.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.56 / $218.57 / $331.40
| Professional | | $159.56 | $218.57 | $331.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.20 / $161.53 / $228.05
| Professional | | $100.20 | $161.53 | $228.05 |