- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $0.85 / $0.85
| Facility | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $467.74 / $977.24
| Professional | | $257.04 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $346.74
| Professional | | $190.55 | $309.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $281.84 / $457.09 / $524.81
| Professional | 50 | $281.84 | $457.09 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $1,071.52
| Professional | | $331.13 | $436.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $309.03 / $616.60
| Professional | | $234.42 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $0.85 / $0.85
| Facility | | $0.85 | $0.85 | $0.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $1,230.27
| Professional | | $257.04 | $446.68 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $1,862.09
| Professional | 50 | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $660.69 / $912.01
| Professional | | $302.00 | $660.69 | $912.01 |