- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.27 / $326.27 / $326.27
| Facility | | $326.27 | $326.27 | $326.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.47 / $278.27 / $326.27
| Professional | | $246.47 | $278.27 | $326.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.26 / $671.30 / $768.03
| Facility | | $520.26 | $671.30 | $768.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.60 / $308.60 / $331.20
| Professional | | $308.60 | $308.60 | $331.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.30 / $324.30 / $324.30
| Facility | | $324.30 | $324.30 | $324.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.74 / $236.74 / $236.74
| Professional | | $236.74 | $236.74 | $236.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.35 / $436.35 / $436.35
| Facility | | $436.35 | $436.35 | $436.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.64 / $436.35 / $588.29
| Professional | | $415.64 | $436.35 | $588.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.73 / $329.73 / $329.73
| Professional | | $329.73 | $329.73 | $329.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.52 / $334.91 / $558.17
| Professional | | $253.52 | $334.91 | $558.17 |