- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.37 / $276.69 / $284.32
| Facility | | $260.37 | $276.69 | $284.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.37 / $272.07 / $321.82
| Professional | | $260.37 | $272.07 | $321.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.71 / $273.77 / $273.77
| Professional | | $232.71 | $273.77 | $273.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.37 / $276.69 / $284.32
| Facility | | $260.37 | $276.69 | $284.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.05 / $268.52 / $315.30
| Professional | | $255.05 | $268.52 | $315.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $258.47
| Professional | | $258.47 | $258.47 | $258.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $289.98
| Professional | | $258.47 | $258.47 | $289.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.79 / $252.79 / $252.79
| Professional | | $252.79 | $252.79 | $252.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $258.47
| Professional | | $258.47 | $258.47 | $258.47 |