- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.42 / $348.42 / $375.45
| Facility | | $348.42 | $348.42 | $375.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.65 / $127.65 / $127.65
| Professional | | $127.65 | $127.65 | $127.65 |
- 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
- $63.43 / $63.43 / $63.43
| Professional | | $63.43 | $63.43 | $63.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.43 / $63.43 / $63.43
| Facility | | $63.43 | $63.43 | $63.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.43 / $63.43 / $63.43
| Professional | | $63.43 | $63.43 | $63.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.42 / $348.42 / $375.45
| Facility | | $348.42 | $348.42 | $375.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.65 / $127.65 / $375.45
| Professional | | $127.65 | $127.65 | $375.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.43 / $125.15 / $181.47
| Professional | | $63.43 | $125.15 | $181.47 |