- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.52 / $634.75 / $2,495.07
| Facility | | $377.52 | $634.75 | $2,495.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.48 / $377.52 / $415.27
| Professional | | $376.48 | $377.52 | $415.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.15 / $377.52 / $388.47
| Facility | | $356.15 | $377.52 | $388.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $377.52
| Professional | | $377.52 | $377.52 | $377.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.87 / $377.52 / $377.52
| Facility | | $115.87 | $377.52 | $377.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $384.64 / $384.64
| Professional | | $377.52 | $384.64 | $384.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $400.17 / $420.26
| Professional | | $377.52 | $400.17 | $420.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.48 / $376.48 / $377.52
| Professional | | $376.48 | $376.48 | $377.52 |