- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $309.03 / $446.68
| Professional | | $269.15 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $457.09 / $602.56
| Professional | | $407.38 | $457.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $741.31
| Facility | | $346.74 | $602.56 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $346.74 / $602.56
| Professional | | $288.40 | $346.74 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $912.01
| Facility | | $602.56 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $602.56
| Facility | | $371.54 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $512.86
| Professional | | $269.15 | $269.15 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $389.05 / $467.74
| Facility | | $213.80 | $389.05 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $416.87
| Professional | | $186.21 | $288.40 | $416.87 |