- 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 / $524.81
| Professional | | $426.58 | $426.58 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $0.03
| Facility | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $524.81
| Professional | | $398.11 | $398.11 | $524.81 |
- 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 / $478.63
| Professional | | $426.58 | $426.58 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $524.81 / $1,318.26
| Facility | | $245.47 | $524.81 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $524.81 / $630.96
| Professional | | $446.68 | $524.81 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $524.81
| Facility | | $398.11 | $398.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $524.81 / $630.96
| Professional | | $512.86 | $524.81 | $630.96 |