- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.61 / $364.73 / $576.27
| Facility | | $243.61 | $364.73 | $576.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.15 / $243.61 / $255.31
| Professional | | $243.15 | $243.61 | $255.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.82 / $243.61 / $247.75
| Facility | | $229.82 | $243.61 | $247.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.61 / $243.61 / $243.61
| Professional | | $243.61 | $243.61 | $243.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.53 / $243.61 / $243.61
| Facility | | $170.53 | $243.61 | $243.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.61 / $257.39 / $257.39
| Professional | | $243.61 | $257.39 | $257.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.77 / $235.77 / $235.77
| Professional | | $235.77 | $235.77 | $235.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.44 / $243.61 / $243.61
| Professional | | $97.44 | $243.61 | $243.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.15 / $243.15 / $243.61
| Professional | | $243.15 | $243.15 | $243.61 |