- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $273.57 / $273.57 / $273.57
| Facility | | $273.57 | $273.57 | $273.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.75 / $255.97 / $306.38
| Professional | | $236.75 | $255.97 | $306.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.22 / $562.86 / $643.97
| Facility | | $436.22 | $562.86 | $643.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.66 / $307.66 / $325.54
| Professional | | $307.66 | $307.66 | $325.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $361.45
| Facility | | $361.45 | $361.45 | $361.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $263.86 / $361.45
| Professional | | $263.86 | $263.86 | $361.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.86 / $365.86 / $365.86
| Facility | | $365.86 | $365.86 | $365.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.86 / $382.34 / $541.15
| Professional | | $365.86 | $382.34 | $541.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.66 / $260.66 / $260.66
| Facility | | $260.66 | $260.66 | $260.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.46 / $347.46 / $347.46
| Professional | | $347.46 | $347.46 | $347.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.30 / $280.80 / $468.00
| Professional | | $214.30 | $280.80 | $468.00 |