- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.67 / $220.67 / $220.67
| Facility | | $220.67 | $220.67 | $220.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.57 / $220.67 / $220.67
| Professional | | $187.57 | $220.67 | $220.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.48 / $75.40 / $216.55
| Facility | | $64.48 | $75.40 | $216.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.57 / $187.57 / $187.57
| Professional | | $187.57 | $187.57 | $187.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.14 / $305.81 / $372.93
| Facility | | $259.14 | $305.81 | $372.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.40 / $790.40 / $790.40
| Professional | | $790.40 | $790.40 | $790.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.55 / $316.08 / $844.50
| Facility | | $216.55 | $316.08 | $844.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.04 / $246.04 / $246.04
| Professional | | $246.04 | $246.04 | $246.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.22 / $241.22 / $241.22
| Facility | | $241.22 | $241.22 | $241.22 |