- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $229.09
| Professional | | $107.15 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | 50 | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $213.80
| Professional | | $190.55 | $190.55 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $134.90 / $213.80
| Professional | | $123.03 | $134.90 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $218.78 / $251.19
| Facility | | $204.17 | $218.78 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $218.78 / $251.19
| Professional | | $204.17 | $218.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $138.04 / $229.09
| Facility | | $104.71 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $162.18 / $234.42
| Professional | | $79.43 | $162.18 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $251.19
| Professional | | $177.83 | $208.93 | $251.19 |