- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.75 / $328.75 / $328.75
| Facility | | $328.75 | $328.75 | $328.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.35 / $323.33 / $330.90
| Professional | | $294.35 | $323.33 | $330.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.20 / $676.39 / $773.86
| Facility | | $524.20 | $676.39 | $773.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.47 / $392.47 / $392.47
| Professional | | $392.47 | $392.47 | $392.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.50 / $437.50 / $437.50
| Facility | | $437.50 | $437.50 | $437.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.38 / $319.38 / $437.50
| Professional | | $319.38 | $319.38 | $437.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $439.65 / $439.65 / $439.65
| Facility | | $439.65 | $439.65 | $439.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.65 / $439.65 / $622.28
| Professional | | $439.65 | $439.65 | $622.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.52 / $337.45 / $562.41
| Professional | | $257.52 | $337.45 | $562.41 |