- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.10 / $355.43 / $604.23
| Facility | | $329.10 | $355.43 | $604.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.38 / $355.38 / $355.38
| Professional | | $355.38 | $355.38 | $355.38 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $329.10 / $355.43 / $508.26
| Facility | | $329.10 | $355.43 | $508.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.85 / $329.10 / $329.10
| Professional | | $318.85 | $329.10 | $329.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $335.63
| Professional | | $329.05 | $329.05 | $335.63 |