- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.64 / $1,100.64 / $1,100.64
| Facility | | $1,100.64 | $1,100.64 | $1,100.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.04 / $117.85 / $193.86
| Professional | | $82.04 | $117.85 | $193.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.07 / $133.69 / $193.43
| Professional | | $98.07 | $133.69 | $193.43 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.10 / $200.55 / $290.14
| Professional | 50 | $147.10 | $200.55 | $290.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.35 / $167.04 / $264.02
| Professional | | $114.35 | $167.04 | $264.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.70 / $148.38 / $230.89
| Professional | | $104.70 | $148.38 | $230.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,100.64 / $1,100.64 / $1,100.64
| Facility | | $1,100.64 | $1,100.64 | $1,100.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.20 / $117.85 / $166.72
| Professional | | $84.20 | $117.85 | $166.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.84 / $162.84 / $243.25
| Professional | | $117.84 | $162.84 | $243.25 |