- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $151.68 / $329.76
| Facility | | $45.71 | $151.68 | $329.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.10 / $71.63 / $106.46
| Professional | | $27.10 | $71.63 | $106.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.95 / $131.24 / $218.84
| Professional | | $51.95 | $131.24 | $218.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $77.93 / $110.55 / $327.12
| Professional | 50 | $77.93 | $110.55 | $327.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.34 / $86.30 / $284.01
| Professional | | $39.34 | $86.30 | $284.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.50 / $91.30 / $183.32
| Facility | | $28.50 | $91.30 | $183.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.27 / $126.72 / $324.12
| Professional | | $84.27 | $126.72 | $324.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.14 / $306.14 / $306.14
| Facility | | $306.14 | $306.14 | $306.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.67 / $126.72 / $201.67
| Professional | | $91.67 | $126.72 | $201.67 |