- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.26 / $522.26 / $562.78
| Facility | | $522.26 | $522.26 | $562.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $234.20 / $309.14
| Professional | | $225.11 | $234.20 | $309.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.84 / $273.44 / $713.37
| Facility | | $217.84 | $273.44 | $713.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $225.11
| Professional | | $225.11 | $225.11 | $225.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $225.11
| Facility | | $225.11 | $225.11 | $225.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $225.11
| Professional | | $225.11 | $225.11 | $225.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $272.61
| Professional | | $225.11 | $225.11 | $272.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.26 / $522.26 / $562.78
| Facility | | $522.26 | $522.26 | $562.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $258.87 / $562.78
| Professional | | $225.11 | $258.87 | $562.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.11 / $225.11 / $326.41
| Professional | | $225.11 | $225.11 | $326.41 |