- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.04 / $257.99 / $736.67
| Facility | | $249.04 | $257.99 | $736.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $257.99 / $257.99
| Professional | | $257.99 | $257.99 | $257.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.62 / $392.20 / $773.33
| Facility | | $250.62 | $392.20 | $773.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.19 / $232.19 / $232.19
| Professional | | $232.19 | $232.19 | $232.19 |
- 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 / $253.60
| Professional | | $253.60 | $253.60 | $253.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.41 / $244.41 / $244.41
| Facility | | $244.41 | $244.41 | $244.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.41 / $298.73 / $360.10
| Professional | | $244.41 | $298.73 | $360.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.41 / $257.99 / $283.79
| Professional | | $244.41 | $257.99 | $283.79 |