- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.11 / $356.58 / $765.08
| Facility | | $346.11 | $356.58 | $765.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.11 / $346.19 / $418.89
| Professional | | $346.11 | $346.19 | $418.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.01 / $307.42 / $361.51
| Facility | | $262.01 | $307.42 | $361.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.51 / $361.51 / $368.74
| Professional | | $361.51 | $361.51 | $368.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.52 / $326.52 / $346.11
| Facility | | $326.52 | $326.52 | $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 |