- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.98 / $551.21 / $1,638.66
| Facility | | $238.98 | $551.21 | $1,638.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $260.27
| Professional | | $236.62 | $236.62 | $260.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.62 / $473.24 / $572.62
| Facility | | $236.62 | $473.24 | $572.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $326.52
| Professional | | $236.62 | $236.62 | $326.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.62 / $260.27 / $354.93
| Facility | | $236.62 | $260.27 | $354.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $260.27
| Professional | | $236.62 | $236.62 | $260.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $236.62
| Facility | | $236.62 | $236.62 | $236.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $267.87
| Professional | | $236.62 | $236.62 | $267.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $250.82 / $283.94
| Professional | | $236.62 | $250.82 | $283.94 |