- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.46 / $536.45 / $1,046.52
| Facility | | $232.46 | $536.45 | $1,046.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $232.46 / $232.46
| Professional | | $230.15 | $232.46 | $232.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $460.30 / $609.90
| Facility | | $230.15 | $460.30 | $609.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.62 / $230.15 / $326.81
| Professional | | $195.62 | $230.15 | $326.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $345.23
| Facility | | $230.15 | $230.15 | $345.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $287.69
| Professional | | $230.15 | $230.15 | $287.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $534.98
| Facility | | $230.15 | $230.15 | $534.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.32 / $230.15 / $614.67
| Professional | | $208.32 | $230.15 | $614.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $285.39
| Professional | | $230.15 | $230.15 | $285.39 |