- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.94 / $700.70 / $700.70
| Facility | | $575.94 | $700.70 | $700.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,560.41 / $1,560.41 / $1,560.41
| Professional | | $1,560.41 | $1,560.41 | $1,560.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $667.17 / $904.19 / $1,697.40
| Facility | | $667.17 | $904.19 | $1,697.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.54 / $811.67 / $913.43
| Facility | | $682.54 | $811.67 | $913.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.69 / $515.04 / $703.21
| Facility | | $437.69 | $515.04 | $703.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.72 / $993.44 / $1,233.70
| Facility | | $487.72 | $993.44 | $1,233.70 |