- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.67 / $308.67 / $308.67
| Facility | | $308.67 | $308.67 | $308.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.74 / $235.13 / $308.67
| Professional | | $211.74 | $235.13 | $308.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.18 / $635.07 / $726.58
| Facility | | $492.18 | $635.07 | $726.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.64 / $289.64 / $303.95
| Professional | | $289.64 | $289.64 | $303.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.62 / $297.62 / $297.62
| Facility | | $297.62 | $297.62 | $297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $217.26 / $297.62
| Professional | | $217.26 | $217.26 | $297.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.80 / $412.80 / $412.80
| Facility | | $412.80 | $412.80 | $412.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.26 / $412.80 / $535.21
| Professional | | $316.26 | $412.80 | $535.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.60 / $302.60 / $302.60
| Professional | | $302.60 | $302.60 | $302.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.76 / $316.83 / $592.38
| Professional | | $215.76 | $316.83 | $592.38 |