- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $295.12 / $524.81
| Facility | | $154.88 | $295.12 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $346.74
| Professional | | $204.17 | $295.12 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $234.42 / $275.42
| Professional | | $141.25 | $234.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Facility | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $338.84
| Professional | | $331.13 | $331.13 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Professional | | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $354.81 / $407.38
| Facility | | $331.13 | $354.81 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $323.59 / $346.74
| Professional | | $275.42 | $323.59 | $346.74 |