- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $117.49 / $204.17
| Professional | | $46.77 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $83.18 / $186.21
| Professional | | $33.88 | $83.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $50.12 / $123.03 / $281.84
| Professional | 50 | $50.12 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $138.04 / $223.87
| Professional | | $48.98 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $141.25 / $229.09
| Professional | | $41.69 | $141.25 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $128.82 / $208.93
| Professional | | $48.98 | $128.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $141.25 / $234.42
| Professional | | $54.95 | $141.25 | $234.42 |