- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $343.14
| Facility | | $326.80 | $326.80 | $343.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.58 / $319.11 / $326.80
| Professional | | $307.58 | $319.11 | $326.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.36 / $320.36 / $320.36
| Facility | | $320.36 | $320.36 | $320.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.36 / $320.36 / $320.36
| Professional | | $320.36 | $320.36 | $320.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.04 / $326.80 / $326.80
| Facility | | $308.04 | $326.80 | $326.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.80 / $326.80 / $326.80
| Professional | | $326.80 | $326.80 | $326.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.37 / $320.39 / $346.72
| Professional | | $304.37 | $320.39 | $346.72 |