- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $900.81
| Facility | | $529.89 | $529.89 | $900.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $667.66
| Professional | | $529.89 | $529.89 | $667.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.88 / $624.88 / $1,059.78
| Facility | | $599.88 | $624.88 | $1,059.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.40 / $529.89 / $529.89
| Professional | | $450.40 | $529.89 | $529.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.89 / $575.76 / $847.82
| Facility | | $529.89 | $575.76 | $847.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $582.88 / $816.03
| Professional | | $529.89 | $582.88 | $816.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.09 / $529.89 / $529.89
| Facility | | $527.09 | $529.89 | $529.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $994.58 / $994.58
| Professional | | $529.89 | $994.58 | $994.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.89 / $529.89 / $529.89
| Professional | | $529.89 | $529.89 | $529.89 |