- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $58.14 / $70.23
| Facility | | $38.76 | $58.14 | $70.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.10 / $38.76 / $66.14
| Professional | | $30.10 | $38.76 | $66.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.62 / $76.62 / $83.36
| Facility | | $76.62 | $76.62 | $83.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.94 / $111.27 / $186.83
| Facility | | $70.94 | $111.27 | $186.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.01 / $96.23 / $123.73
| Professional | | $53.01 | $96.23 | $123.73 |