- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $688.92 / $877.06
| Facility | | $346.11 | $688.92 | $877.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $418.89
| Professional | | $346.11 | $346.11 | $418.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.72 / $607.70 / $1,107.55
| Facility | | $380.72 | $607.70 | $1,107.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $346.11
| Professional | | $346.11 | $346.11 | $346.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.52 / $326.52 / $489.77
| Facility | | $326.52 | $326.52 | $489.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $346.11
| Professional | | $346.11 | $346.11 | $346.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.19 / $394.21 / $574.12
| Facility | | $346.19 | $394.21 | $574.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.58 / $380.72 / $567.62
| Professional | | $259.58 | $380.72 | $567.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $346.11
| Professional | | $346.11 | $346.11 | $346.11 |