- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.13 / $342.08 / $381.56
| Facility | | $257.13 | $342.08 | $381.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.87 / $146.28 / $290.04
| Professional | | $71.87 | $146.28 | $290.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.15 / $111.96 / $146.24
| Professional | | $93.15 | $111.96 | $146.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $140.80 / $167.95 / $219.36
| Professional | 50 | $140.80 | $167.95 | $219.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.77 / $206.57 / $516.50
| Professional | | $96.77 | $206.57 | $516.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.63 / $220.57 / $463.08
| Professional | | $95.63 | $220.57 | $463.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.13 / $342.08 / $735.71
| Facility | | $257.13 | $342.08 | $735.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.45 / $140.86 / $376.70
| Professional | | $82.45 | $140.86 | $376.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.36 / $304.14 / $495.50
| Professional | | $183.36 | $304.14 | $495.50 |