- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.39 / $253.36 / $260.81
| Facility | | $248.39 | $253.36 | $260.81 |
- 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
- $261.36 / $271.12 / $271.12
| Facility | | $261.36 | $271.12 | $271.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.12 / $271.12 / $271.12
| Professional | | $271.12 | $271.12 | $271.12 |
- 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
- $235.97 / $248.39 / $268.80
| Professional | | $235.97 | $248.39 | $268.80 |