- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.10 / $227.28 / $272.73
| Facility | | $227.10 | $227.28 | $272.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $338.38
| Professional | | $227.28 | $227.28 | $338.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.11 / $227.11 / $227.27
| Professional | | $227.11 | $227.11 | $227.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.09 / $224.09 / $244.09
| Facility | | $224.09 | $224.09 | $244.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $268.02
| Professional | | $227.28 | $227.28 | $268.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.19 / $227.28 / $262.33
| Professional | | $193.19 | $227.28 | $262.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $253.01 / $275.01
| Professional | | $227.28 | $253.01 | $275.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.09 / $224.09 / $306.58
| Professional | | $224.09 | $224.09 | $306.58 |