- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.65 / $246.65 / $246.65
| Facility | | $246.65 | $246.65 | $246.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.07 / $206.35 / $246.65
| Professional | | $191.07 | $206.35 | $246.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.28 / $507.46 / $580.58
| Facility | | $393.28 | $507.46 | $580.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.11 / $266.11 / $278.49
| Professional | | $266.11 | $266.11 | $278.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.26 / $366.26 / $366.26
| Facility | | $366.26 | $366.26 | $366.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.37 / $267.37 / $366.26
| Professional | | $267.37 | $267.37 | $366.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.85 / $329.85 / $329.85
| Facility | | $329.85 | $329.85 | $329.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.38 / $329.85 / $432.23
| Professional | | $305.38 | $329.85 | $432.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.25 / $277.25 / $277.25
| Professional | | $277.25 | $277.25 | $277.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.20 / $253.17 / $335.50
| Professional | | $193.20 | $253.17 | $335.50 |