- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $436.52
| Facility | | $363.08 | $363.08 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $234.42 / $436.52
| Professional | | $114.82 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $346.74
| Professional | | $338.84 | $338.84 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $407.38
| Professional | | $346.74 | $346.74 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $870.96
| Professional | | $501.19 | $501.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $436.52
| Facility | | $177.83 | $257.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $346.74 / $501.19
| Professional | | $120.23 | $346.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $891.25
| Facility | | $562.34 | $562.34 | $891.25 |