- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.48 / $265.48 / $265.48
| Facility | | $265.48 | $265.48 | $265.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.70 / $246.35 / $266.06
| Professional | | $237.70 | $246.35 | $266.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.33 / $546.23 / $624.94
| Facility | | $423.33 | $546.23 | $624.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.45 / $305.45 / $319.05
| Professional | | $305.45 | $305.45 | $319.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.03 / $362.03 / $362.03
| Facility | | $362.03 | $362.03 | $362.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.27 / $264.27 / $362.03
| Professional | | $264.27 | $264.27 | $362.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.05 / $355.05 / $355.05
| Facility | | $355.05 | $355.05 | $355.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.05 / $355.05 / $502.53
| Professional | | $355.05 | $355.05 | $502.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.25 / $326.25 / $326.25
| Professional | | $326.25 | $326.25 | $326.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.96 / $272.51 / $381.69
| Professional | | $207.96 | $272.51 | $381.69 |