- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.14 / $716.14 / $771.70
| Facility | | $716.14 | $716.14 | $771.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.02 / $371.23 / $371.23
| Professional | | $321.02 | $371.23 | $371.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.70 / $374.95 / $978.21
| Facility | | $298.70 | $374.95 | $978.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Professional | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Facility | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Professional | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $373.81
| Professional | | $308.68 | $308.68 | $373.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.14 / $716.14 / $771.70
| Facility | | $716.14 | $716.14 | $771.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.02 / $371.23 / $771.70
| Professional | | $321.02 | $371.23 | $771.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $463.02
| Professional | | $308.68 | $308.68 | $463.02 |