- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.39 / $306.83 / $968.73
| Facility | | $248.39 | $306.83 | $968.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $247.40 / $253.36
| Professional | | $238.46 | $247.40 | $253.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.84 / $385.11 / $748.74
| Facility | | $255.84 | $385.11 | $748.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $248.39 / $268.83
| Professional | | $238.46 | $248.39 | $268.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.36 / $253.36 / $253.36
| Facility | | $253.36 | $253.36 | $253.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.36 / $253.36 / $253.36
| Professional | | $253.36 | $253.36 | $253.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.39 / $248.39 / $275.22
| Professional | | $248.39 | $248.39 | $275.22 |