- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $519.29 / $789.31
| Facility | | $346.11 | $519.29 | $789.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $380.72
| Professional | | $346.11 | $346.11 | $380.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.52 / $346.11 / $355.83
| Facility | | $326.52 | $346.11 | $355.83 |
- 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
- $346.11 / $346.11 / $346.11
| Facility | | $346.11 | $346.11 | $346.11 |
- 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
- $346.11 / $346.11 / $346.11
| Facility | | $346.11 | $346.11 | $346.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $415.01
| Professional | | $346.11 | $346.11 | $415.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.19 / $346.19
| Professional | | $346.11 | $346.19 | $346.19 |