- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.37 / $218.79 / $286.14
| Facility | | $208.37 | $218.79 | $286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.37 / $240.84 / $286.14
| Professional | | $208.37 | $240.84 | $286.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.38 / $188.38 / $188.38
| Facility | | $188.38 | $188.38 | $188.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.09 / $188.38 / $188.38
| Professional | | $151.09 | $188.38 | $188.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.96 / $238.46 / $259.11
| Facility | | $224.96 | $238.46 | $259.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $238.46 / $258.70
| Professional | | $238.46 | $238.46 | $258.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.46 / $252.77 / $306.38
| Professional | | $238.46 | $252.77 | $306.38 |