- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.29 / $289.08 / $289.08
| Facility | | $238.29 | $289.08 | $289.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.27 / $282.27 / $289.08
| Professional | | $282.27 | $282.27 | $289.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.12 / $169.12 / $169.12
| Facility | | $169.12 | $169.12 | $169.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.77 / $169.12 / $169.12
| Professional | | $161.77 | $169.12 | $169.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.64 / $289.08 / $289.08
| Facility | | $177.64 | $289.08 | $289.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.08 / $289.08 / $289.08
| Professional | | $289.08 | $289.08 | $289.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.42 / $283.42 / $330.06
| Professional | | $283.42 | $283.42 | $330.06 |