- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.01 / $257.99 / $386.99
| Facility | | $135.01 | $257.99 | $386.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.00 / $257.99 / $283.77
| Professional | | $236.00 | $257.99 | $283.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.89 / $279.89 / $279.89
| Facility | | $279.89 | $279.89 | $279.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.72 / $279.89 / $279.89
| Professional | | $267.72 | $279.89 | $279.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.28 / $253.60 / $253.60
| Facility | | $237.28 | $253.60 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.60 / $253.60 / $253.60
| Professional | | $253.60 | $253.60 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.09 / $271.57 / $291.52
| Professional | | $245.09 | $271.57 | $291.52 |