- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.42 / $320.60 / $349.16
| Facility | | $317.42 | $320.60 | $349.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $334.46
| Professional | | $318.52 | $318.52 | $334.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $350.38 / $477.80
| Facility | | $318.52 | $350.38 | $477.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $738.53
| Professional | | $318.52 | $318.52 | $738.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.50 / $313.00 / $318.52
| Facility | | $300.50 | $313.00 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $330.55
| Professional | | $318.52 | $318.52 | $330.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $350.38 / $374.18
| Professional | | $318.52 | $350.38 | $374.18 |