- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.52 / $789.52 / $850.78
| Facility | | $789.52 | $789.52 | $850.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.93 / $353.93 / $411.11
| Professional | | $353.93 | $353.93 | $411.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.32 / $413.37 / $1,078.44
| Facility | | $329.32 | $413.37 | $1,078.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $340.31
| Professional | | $340.31 | $340.31 | $340.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.91 / $340.31 / $599.80
| Facility | | $328.91 | $340.31 | $599.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $340.31
| Professional | | $340.31 | $340.31 | $340.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $412.12
| Professional | | $340.31 | $340.31 | $412.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.52 / $789.52 / $850.78
| Facility | | $789.52 | $789.52 | $850.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $356.75 / $570.79
| Professional | | $340.31 | $356.75 | $570.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.26 / $340.31 / $510.47
| Professional | | $289.26 | $340.31 | $510.47 |