- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.10 / $345.56 / $822.75
| Facility | | $329.10 | $345.56 | $822.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $332.34 / $398.21
| Professional | | $329.05 | $332.34 | $398.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.67 / $276.52 / $350.74
| Facility | | $235.67 | $276.52 | $350.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.74 / $350.74 / $357.75
| Professional | | $350.74 | $350.74 | $357.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.43 / $310.43 / $329.05
| Facility | | $310.43 | $310.43 | $329.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $329.05
| Professional | | $329.05 | $329.05 | $329.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.47 / $329.05 / $375.02
| Professional | | $322.47 | $329.05 | $375.02 |