- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $426.58 / $489.78
| Facility | | $0.83 | $426.58 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $77.62 / $151.36
| Professional | | $51.29 | $77.62 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $70.79 / $87.10
| Professional | | $41.69 | $70.79 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $63.10 / $107.15 / $128.82
| Professional | 50 | $63.10 | $107.15 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $104.71 / $144.54
| Professional | | $77.62 | $104.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $81.28 / $125.89
| Professional | | $51.29 | $81.28 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $380.19 / $489.78
| Facility | | $0.83 | $380.19 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $81.28 / $151.36
| Professional | | $54.95 | $81.28 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $81.28 / $123.03
| Professional | | $52.48 | $81.28 | $123.03 |