- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.42 / $380.90 / $390.59
| Facility | | $317.42 | $380.90 | $390.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.42 / $318.52 / $331.27
| Professional | | $317.42 | $318.52 | $331.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.80 / $573.35 / $1,392.20
| Facility | | $380.80 | $573.35 | $1,392.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Professional | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.50 / $318.52 / $318.52
| Facility | | $300.50 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Professional | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $533.76
| Professional | | $318.52 | $318.52 | $533.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $337.64
| Professional | | $318.52 | $318.52 | $337.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.63 / $310.08 / $387.28
| Professional | | $276.63 | $310.08 | $387.28 |