- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.26 / $237.17 / $281.74
| Facility | | $230.26 | $237.17 | $281.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.26 / $234.76 / $279.07
| Professional | | $230.26 | $234.76 | $279.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.15 / $391.26 / $826.70
| Facility | | $230.15 | $391.26 | $826.70 |
- 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
- $217.13 / $217.13 / $230.15
| Facility | | $217.13 | $217.13 | $230.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.15 / $230.15 / $230.15
| Professional | | $230.15 | $230.15 | $230.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.70 / $266.86 / $1,114.20
| Facility | | $221.70 | $266.86 | $1,114.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.72 / $230.26 / $262.64
| Professional | | $195.72 | $230.26 | $262.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.63 / $230.15 / $266.27
| Professional | | $195.63 | $230.15 | $266.27 |