- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $377.52
| Facility | | $377.52 | $377.52 | $377.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $455.54
| Professional | | $377.52 | $377.52 | $455.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.44 / $377.52 / $471.80
| Professional | | $377.44 | $377.52 | $471.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.72 / $538.37 / $1,031.56
| Facility | | $381.72 | $538.37 | $1,031.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.48 / $412.40 / $419.10
| Professional | | $376.48 | $412.40 | $419.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.10 / $451.78 / $647.45
| Facility | | $311.10 | $451.78 | $647.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.32 / $421.76 / $554.95
| Professional | | $262.32 | $421.76 | $554.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.13 / $413.13 / $413.13
| Professional | | $413.13 | $413.13 | $413.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.52 / $377.52 / $420.26
| Professional | | $377.52 | $377.52 | $420.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.48 / $376.48 / $376.48
| Facility | | $376.48 | $376.48 | $376.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.48 / $376.48 / $376.48
| Professional | | $376.48 | $376.48 | $376.48 |