- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.80 / $276.18 / $276.31
| Facility | | $264.80 | $276.18 | $276.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $232.46 / $276.18
| Professional | | $230.15 | $232.46 | $276.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.81 / $249.81 / $249.81
| Facility | | $249.81 | $249.81 | $249.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.25 / $249.81 / $249.81
| Professional | | $231.25 | $249.81 | $249.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.44 / $217.13 / $230.15
| Facility | | $196.44 | $217.13 | $230.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.81 / $230.15 / $230.15
| Professional | | $227.81 | $230.15 | $230.15 |