- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Facility | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $371.23
| Professional | | $308.68 | $308.68 | $371.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.51 / $314.51 / $314.51
| Facility | | $314.51 | $314.51 | $314.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.48 / $308.68 / $374.34
| Professional | | $299.48 | $308.68 | $374.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.12 / $438.72 / $840.63
| Facility | | $345.12 | $438.72 | $840.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.94 / $306.80 / $337.48
| Professional | | $293.94 | $306.80 | $337.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.71 / $368.15 / $514.36
| Facility | | $352.71 | $368.15 | $514.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.20 / $352.72 / $640.34
| Professional | | $284.20 | $352.72 | $640.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.43 / $337.80 / $337.80
| Professional | | $307.43 | $337.80 | $337.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $339.55
| Professional | | $308.68 | $308.68 | $339.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.80 / $306.80 / $306.80
| Facility | | $306.80 | $306.80 | $306.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.80 / $306.80 / $306.80
| Professional | | $306.80 | $306.80 | $306.80 |