- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.45 / $239.86 / $268.76
| Facility | | $228.45 | $239.86 | $268.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.95 / $239.86 / $263.83
| Professional | | $226.95 | $239.86 | $263.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.32 / $372.92 / $726.69
| Facility | | $256.32 | $372.92 | $726.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.45 / $228.45 / $242.43
| Professional | | $228.45 | $228.45 | $242.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.38 / $263.38 / $263.38
| Facility | | $263.38 | $263.38 | $263.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.38 / $263.38 / $263.38
| Professional | | $263.38 | $263.38 | $263.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.16 / $270.43 / $282.19
| Professional | | $235.16 | $270.43 | $282.19 |