- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.76 / $645.54 / $783.73
| Facility | | $339.76 | $645.54 | $783.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.31 / $340.31 / $370.94
| Professional | | $340.31 | $340.31 | $370.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.38 / $357.33 / $1,085.58
| Facility | | $311.38 | $357.33 | $1,085.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.76 / $340.31 / $340.31
| Professional | | $339.76 | $340.31 | $340.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.91 / $340.31 / $340.31
| Facility | | $328.91 | $340.31 | $340.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.91 / $340.31 / $433.08
| Professional | | $328.91 | $340.31 | $433.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.91 / $369.21 / $386.95
| Professional | | $328.91 | $369.21 | $386.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.56 / $368.56 / $368.56
| Facility | | $368.56 | $368.56 | $368.56 |
- 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
- $221.20 / $340.31 / $340.31
| Professional | | $221.20 | $340.31 | $340.31 |