- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.31 / $417.56 / $751.54
| Facility | | $340.31 | $417.56 | $751.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $343.16 / $411.11
| Professional | | $340.31 | $343.16 | $411.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.61 / $544.04 / $1,087.28
| Facility | | $344.61 | $544.04 | $1,087.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $346.73
| Professional | | $340.31 | $340.31 | $346.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.05 / $340.31 / $340.31
| Facility | | $321.05 | $340.31 | $340.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $361.86
| Professional | | $340.31 | $340.31 | $361.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.22 / $340.22 / $340.22
| Facility | | $340.22 | $340.22 | $340.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.12 / $340.31 / $368.08
| Professional | | $136.12 | $340.31 | $368.08 |