- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.05 / $329.05 / $565.39
| Professional | | $329.05 | $329.05 | $565.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.51 / $372.51 / $372.51
| Facility | | $372.51 | $372.51 | $372.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.43 / $360.96 / $601.61
| Facility | | $310.43 | $360.96 | $601.61 |
- 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
- $310.43 / $360.96 / $601.61
| Facility | | $310.43 | $360.96 | $601.61 |
- 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
- $312.60 / $329.05 / $506.18
| Professional | | $312.60 | $329.05 | $506.18 |