- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.61 / $263.61 / $263.61
| Facility | | $263.61 | $263.61 | $263.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.75 / $254.01 / $263.61
| Professional | | $204.75 | $254.01 | $263.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.34 / $542.37 / $620.53
| Facility | | $420.34 | $542.37 | $620.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.79 / $263.79 / $277.67
| Professional | | $263.79 | $263.79 | $277.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.54 / $274.54 / $274.54
| Facility | | $274.54 | $274.54 | $274.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.41 / $200.41 / $200.41
| Professional | | $200.41 | $200.41 | $200.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.54 / $352.54 / $352.54
| Facility | | $352.54 | $352.54 | $352.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.54 / $377.10 / $533.75
| Professional | | $352.54 | $377.10 | $533.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.45 / $276.45 / $276.45
| Professional | | $276.45 | $276.45 | $276.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.50 / $270.58 / $345.67
| Professional | | $206.50 | $270.58 | $345.67 |