- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.02 / $352.51 / $359.49
| Facility | | $349.02 | $352.51 | $359.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.02 / $349.02 / $378.13
| Professional | | $349.02 | $349.02 | $378.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $349.01 / $408.00 / $673.59
| Facility | | $349.01 | $408.00 | $673.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.02 / $349.02 / $408.06
| Professional | | $349.02 | $349.02 | $408.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.26 / $349.01 / $349.01
| Facility | | $329.26 | $349.01 | $349.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.01 / $349.01 / $378.65
| Professional | | $349.01 | $349.01 | $378.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.02 / $349.02 / $401.37
| Professional | | $349.02 | $349.02 | $401.37 |