- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.28 / $431.49 / $523.42
| Facility | | $227.28 | $431.49 | $523.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $475.56
| Professional | | $227.28 | $227.28 | $475.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.96 / $238.64 / $725.02
| Facility | | $207.96 | $238.64 | $725.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $235.68
| Professional | | $227.28 | $227.28 | $235.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.09 / $227.28 / $227.28
| Facility | | $224.09 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Professional | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.93 / $246.57 / $291.48
| Professional | | $241.93 | $246.57 | $291.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.23 / $239.23 / $239.23
| Facility | | $239.23 | $239.23 | $239.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Professional | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $240.92
| Professional | | $227.28 | $227.28 | $240.92 |