- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $384.08
| Professional | | $318.52 | $318.52 | $384.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $360.60 / $360.60 / $360.60
| Facility | | $360.60 | $360.60 | $360.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.50 / $354.33 / $590.55
| Facility | | $300.50 | $354.33 | $590.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $590.55
| Professional | | $318.52 | $318.52 | $590.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.50 / $354.33 / $590.55
| Facility | | $300.50 | $354.33 | $590.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $590.55
| Professional | | $318.52 | $318.52 | $590.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.05 / $337.64 / $735.93
| Professional | | $318.05 | $337.64 | $735.93 |