- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.64 / $238.64 / $272.73
| Facility | | $238.64 | $238.64 | $272.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $272.73
| Professional | | $227.28 | $227.28 | $272.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.78 / $152.78 / $168.06
| Facility | | $152.78 | $152.78 | $168.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.34 / $151.34 / $176.74
| Professional | | $151.34 | $151.34 | $176.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.09 / $227.28 / $227.28
| Facility | | $224.09 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Professional | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.76 / $221.71 / $294.87
| Professional | | $211.76 | $221.71 | $294.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Facility | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.92 / $227.28 / $291.48
| Professional | | $215.92 | $227.28 | $291.48 |