- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.98 / $475.98 / $475.98
| Facility | | $475.98 | $475.98 | $475.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.67 / $194.34 / $435.35
| Professional | | $100.67 | $194.34 | $435.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $150.69 / $225.21
| Professional | | $127.04 | $150.69 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.57 / $224.20 / $337.81
| Professional | 50 | $190.57 | $224.20 | $337.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.64 / $531.64 / $531.64
| Facility | | $531.64 | $531.64 | $531.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.22 / $322.37 / $583.73
| Professional | | $178.22 | $322.37 | $583.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.86 / $255.34 / $529.15
| Professional | | $143.86 | $255.34 | $529.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.67 / $194.34 / $433.12
| Professional | | $100.67 | $194.34 | $433.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.15 / $360.99 / $471.58
| Professional | | $215.15 | $360.99 | $471.58 |