- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.34 / $343.47 / $535.64
| Professional | | $206.34 | $343.47 | $535.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $300.00 / $515.21 / $721.29
| Professional | 50 | $300.00 | $515.21 | $721.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.93 / $395.93 / $681.44
| Professional | | $395.93 | $395.93 | $681.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.93 / $395.93 / $395.93
| Facility | | $395.93 | $395.93 | $395.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.01 / $424.28 / $701.89
| Professional | | $259.01 | $424.28 | $701.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.27 / $395.93 / $675.45
| Facility | | $277.27 | $395.93 | $675.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.22 / $424.28 / $695.03
| Professional | | $256.22 | $424.28 | $695.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $200.00
| Facility | | $200.00 | $200.00 | $200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.55 / $712.24 / $822.76
| Professional | | $638.55 | $712.24 | $822.76 |