- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.79 / $165.54 / $263.91
| Facility | | $40.79 | $165.54 | $263.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.74 / $28.05 / $42.62
| Professional | | $27.74 | $28.05 | $42.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.77 / $137.77 / $137.77
| Facility | | $137.77 | $137.77 | $137.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.90 / $30.13 / $56.65
| Professional | | $22.90 | $30.13 | $56.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.09 / $207.09 / $207.09
| Facility | | $207.09 | $207.09 | $207.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.54 / $32.13 / $67.56
| Professional | | $24.54 | $32.13 | $67.56 |