- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.26 / $257.99 / $263.14
| Facility | | $188.26 | $257.99 | $263.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $257.99 / $283.77
| Professional | | $257.99 | $257.99 | $283.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.09 / $177.29 / $238.52
| Facility | | $146.09 | $177.29 | $238.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.43 / $226.43 / $226.43
| Professional | | $226.43 | $226.43 | $226.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.60 / $253.60 / $253.60
| Facility | | $253.60 | $253.60 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.60 / $253.60 / $272.20
| Professional | | $253.60 | $253.60 | $272.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $271.57 / $291.52
| Professional | | $257.99 | $271.57 | $291.52 |