- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.28 / $236.38 / $396.87
| Facility | | $206.28 | $236.38 | $396.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.28 / $213.84 / $257.92
| Professional | | $206.28 | $213.84 | $257.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.37 / $347.59 / $432.73
| Facility | | $220.37 | $347.59 | $432.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.38 / $224.38 / $224.38
| Professional | | $224.38 | $224.38 | $224.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.84 / $213.84 / $213.84
| Facility | | $213.84 | $213.84 | $213.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.84 / $213.84 / $243.00
| Professional | | $213.84 | $213.84 | $243.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.28 / $254.47 / $267.30
| Facility | | $206.28 | $254.47 | $267.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.15 / $206.15 / $206.15
| Professional | | $206.15 | $206.15 | $206.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.84 / $213.84 / $213.84
| Facility | | $213.84 | $213.84 | $213.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.84 / $213.84 / $331.45
| Professional | | $213.84 | $213.84 | $331.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.45 / $311.01 / $1,069.20
| Facility | | $284.45 | $311.01 | $1,069.20 |