- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.45 / $292.58 / $307.22
| Facility | | $292.45 | $292.58 | $307.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $251.02 / $292.58
| Professional | | $243.71 | $251.02 | $292.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.52 / $264.52 / $264.52
| Facility | | $264.52 | $264.52 | $264.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.20 / $264.52 / $264.52
| Professional | | $249.20 | $264.52 | $264.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.92 / $243.71 / $243.71
| Facility | | $229.92 | $243.71 | $243.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $264.39
| Professional | | $243.71 | $243.71 | $264.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.71 / $243.71 / $280.27
| Professional | | $243.71 | $243.71 | $280.27 |