- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.51 / $513.97 / $715.62
| Facility | | $270.51 | $513.97 | $715.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.51 / $270.51 / $277.02
| Professional | | $270.51 | $270.51 | $277.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.51 / $285.18 / $866.40
| Facility | | $248.51 | $285.18 | $866.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $277.02 / $277.02
| Professional | | $271.60 | $277.02 | $277.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.97 / $277.02 / $277.02
| Facility | | $268.97 | $277.02 | $277.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.02 / $277.02 / $277.02
| Professional | | $277.02 | $277.02 | $277.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.92 / $325.92 / $325.92
| Professional | | $325.92 | $325.92 | $325.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.60 / $271.60 / $271.60
| Professional | | $271.60 | $271.60 | $271.60 |