- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.62 / $283.94 / $291.16
| Facility | | $236.62 | $283.94 | $291.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $246.08
| Professional | | $236.62 | $236.62 | $246.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.88 / $425.92 / $1,034.20
| Facility | | $282.88 | $425.92 | $1,034.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $236.62
| Professional | | $236.62 | $236.62 | $236.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.22 / $236.62 / $236.62
| Facility | | $223.22 | $236.62 | $236.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $236.62
| Professional | | $236.62 | $236.62 | $236.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $396.50
| Professional | | $236.62 | $236.62 | $396.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $236.62 / $250.82
| Professional | | $236.62 | $236.62 | $250.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.19 / $226.81 / $288.67
| Professional | | $206.19 | $226.81 | $288.67 |