- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.05 / $580.85 / $771.25
| Facility | | $379.05 | $580.85 | $771.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.22 / $262.22 / $262.22
| Professional | | $262.22 | $262.22 | $262.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.65 / $349.62 / $437.03
| Facility | | $155.65 | $349.62 | $437.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.52 / $279.68 / $559.88
| Professional | | $211.52 | $279.68 | $559.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.96 / $425.96 / $510.35
| Professional | | $425.96 | $425.96 | $510.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.41 / $87.41 / $349.62
| Professional | | $87.41 | $87.41 | $349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.41 / $87.41 / $87.41
| Professional | | $87.41 | $87.41 | $87.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.42 / $524.42 / $524.42
| Facility | | $524.42 | $524.42 | $524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $146.84 / $367.10
| Professional | | $146.84 | $146.84 | $367.10 |