- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.89 / $330.25 / $480.61
| Facility | | $245.89 | $330.25 | $480.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.93 / $337.93 / $428.98
| Professional | | $337.93 | $337.93 | $428.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Professional | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.36 / $337.93 / $483.24
| Facility | | $284.36 | $337.93 | $483.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.87 / $324.02 / $334.54
| Professional | | $260.87 | $324.02 | $334.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.87 / $324.02 / $334.54
| Professional | | $260.87 | $324.02 | $334.54 |