- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $483.72 / $483.72 / $483.72
| Facility | | $483.72 | $483.72 | $483.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $283.77 / $386.98
| Professional | | $257.99 | $283.77 | $386.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.60 / $253.60 / $253.60
| Professional | | $253.60 | $253.60 | $253.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.38 / $553.38 / $553.38
| Facility | | $553.38 | $553.38 | $553.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $257.99 / $830.73
| Professional | | $257.99 | $257.99 | $830.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.20 / $380.20 / $597.45
| Facility | | $380.20 | $380.20 | $597.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.20 / $543.14 / $896.18
| Facility | | $380.20 | $543.14 | $896.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.60 / $253.60 / $279.89
| Professional | | $253.60 | $253.60 | $279.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.99 / $257.99 / $271.57
| Professional | | $257.99 | $257.99 | $271.57 |