- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $501.19
| Facility | | $436.52 | $436.52 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $436.52 / $524.81
| Professional | | $426.58 | $436.52 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.05 / $0.05
| Facility | | $0.02 | $0.05 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $426.58 / $501.19
| Professional | | $338.84 | $426.58 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Professional | | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $446.68
| Professional | | $331.13 | $331.13 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $467.74 / $660.69
| Facility | | $251.19 | $467.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $562.34 / $676.08
| Professional | | $524.81 | $562.34 | $676.08 |