- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.52 / $297.52 / $297.52
| Facility | | $297.52 | $297.52 | $297.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.47 / $297.52 / $382.31
| Professional | | $234.47 | $297.52 | $382.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.26 / $500.46 / $500.46
| Professional | | $482.26 | $500.46 | $500.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $487.65 / $487.65
| Facility | | $487.65 | $487.65 | $487.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.63 / $359.63 / $359.63
| Professional | | $359.63 | $359.63 | $359.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.47 / $300.85 / $405.70
| Professional | | $234.47 | $300.85 | $405.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.10 / $595.10 / $595.10
| Professional | | $595.10 | $595.10 | $595.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.65 / $487.65 / $487.65
| Facility | | $487.65 | $487.65 | $487.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.63 / $359.63 / $359.63
| Professional | | $359.63 | $359.63 | $359.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.83 / $283.23 / $544.04
| Professional | | $208.83 | $283.23 | $544.04 |