- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.86 / $265.24 / $376.71
| Facility | | $249.86 | $265.24 | $376.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.41 / $265.24 / $384.40
| Professional | | $202.41 | $265.24 | $384.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.06 / $277.39 / $462.31
| Professional | | $260.06 | $277.39 | $462.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.39 / $687.42 / $966.27
| Facility | | $402.39 | $687.42 | $966.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.42 / $328.24 / $328.24
| Professional | | $274.42 | $328.24 | $328.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.02 / $312.02 / $312.02
| Facility | | $312.02 | $312.02 | $312.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.98 / $232.98 / $232.98
| Facility | | $232.98 | $232.98 | $232.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.08 / $232.98 / $232.98
| Professional | | $170.08 | $232.98 | $232.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.32 / $228.58 / $305.55
| Professional | | $115.32 | $228.58 | $305.55 |