- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.73 / $231.73 / $231.73
| Facility | | $231.73 | $231.73 | $231.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.17 / $192.29 / $231.73
| Professional | | $165.17 | $192.29 | $231.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.56 / $491.56 / $491.56
| Facility | | $491.56 | $491.56 | $491.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.15 / $447.82 / $559.78
| Professional | | $354.15 | $447.82 | $559.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.66 / $279.14 / $452.57
| Facility | | $232.66 | $279.14 | $452.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.74 / $147.91 / $452.03
| Professional | | $126.74 | $147.91 | $452.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.11 / $452.03 / $540.27
| Facility | | $318.11 | $452.03 | $540.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.82 / $452.03 / $531.35
| Professional | | $295.82 | $452.03 | $531.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.82 / $575.65 / $677.24
| Professional | | $295.82 | $575.65 | $677.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.54 / $126.74 / $246.52
| Professional | | $103.54 | $126.74 | $246.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.52 / $246.52 / $246.52
| Professional | | $246.52 | $246.52 | $246.52 |