- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.71 / $179.71 / $248.18
| Facility | | $179.71 | $179.71 | $248.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.58 / $138.35 / $179.71
| Professional | | $85.58 | $138.35 | $179.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.71 / $107.54 / $255.88
| Facility | | $92.71 | $107.54 | $255.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.37 / $128.37 / $128.37
| Facility | | $128.37 | $128.37 | $128.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.90 / $85.58 / $189.24
| Professional | | $59.90 | $85.58 | $189.24 |