- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.95 / $46.20 / $127.96
| Facility | | $28.95 | $46.20 | $127.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.37 / $28.95 / $88.51
| Professional | | $28.37 | $28.95 | $88.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.63 / $1,513.65 / $2,654.22
| Facility | | $1,044.63 | $1,513.65 | $2,654.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.22 / $37.64 / $65.81
| Professional | | $28.22 | $37.64 | $65.81 |