- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $588.39
| Facility | | $346.11 | $346.11 | $588.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $346.19
| Professional | | $346.11 | $346.11 | $346.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.82 / $408.15 / $692.22
| Facility | | $391.82 | $408.15 | $692.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.19 / $346.11 / $346.11
| Professional | | $294.19 | $346.11 | $346.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $376.11 / $553.78
| Facility | | $346.11 | $376.11 | $553.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $380.72 / $533.01
| Professional | | $346.11 | $380.72 | $533.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $347.23
| Facility | | $346.11 | $346.11 | $347.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $346.11 / $624.96
| Professional | | $317.58 | $346.11 | $624.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.11 / $346.11
| Professional | | $346.11 | $346.11 | $346.11 |