- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.26 / $411.26 / $411.26
| Facility | | $411.26 | $411.26 | $411.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.90 / $216.33 / $433.60
| Professional | | $100.90 | $216.33 | $433.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $149.46 / $223.18
| Professional | | $127.04 | $149.46 | $223.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.57 / $224.20 / $334.78
| Professional | 50 | $190.57 | $224.20 | $334.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.05 / $712.05 / $712.05
| Facility | | $712.05 | $712.05 | $712.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.73 / $293.02 / $558.90
| Professional | | $180.73 | $293.02 | $558.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.38 / $250.94 / $493.22
| Professional | | $141.38 | $250.94 | $493.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.26 / $411.26 / $411.26
| Facility | | $411.26 | $411.26 | $411.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.80 / $216.33 / $433.60
| Professional | | $108.80 | $216.33 | $433.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.32 / $333.73 / $426.23
| Professional | | $227.32 | $333.73 | $426.23 |