- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $603.10 / $733.58
| Facility | | $318.52 | $603.10 | $733.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $369.50
| Professional | | $318.52 | $318.52 | $369.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.45 / $334.46 / $1,016.11
| Facility | | $291.45 | $334.46 | $1,016.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $329.40
| Professional | | $318.52 | $318.52 | $329.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.36 / $318.52 / $318.52
| Facility | | $311.36 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $336.29
| Professional | | $318.52 | $318.52 | $336.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $345.58 / $374.18
| Professional | | $318.05 | $345.58 | $374.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.67 / $339.67 / $339.67
| Facility | | $339.67 | $339.67 | $339.67 |
- 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 / $337.64
| Professional | | $318.52 | $318.52 | $337.64 |