- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.08 / $322.08 / $455.38
| Facility | | $322.08 | $322.08 | $455.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.64 / $133.96 / $201.05
| Professional | | $36.64 | $133.96 | $201.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.18 / $58.26 / $88.57
| Professional | | $48.18 | $58.26 | $88.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.28 / $87.39 / $128.11
| Professional | 50 | $72.28 | $87.39 | $128.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.14 / $171.79 / $337.35
| Professional | | $50.14 | $171.79 | $337.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.46 / $150.51 / $376.78
| Professional | | $49.46 | $150.51 | $376.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.08 / $322.08 / $455.38
| Facility | | $322.08 | $322.08 | $455.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.76 / $131.43 / $212.80
| Professional | | $40.76 | $131.43 | $212.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.68 / $215.71 / $374.48
| Professional | | $161.68 | $215.71 | $374.48 |