- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.73 / $120.05 / $184.15
| Facility | | $102.73 | $120.05 | $184.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.08 / $58.85 / $274.01
| Professional | | $47.08 | $58.85 | $274.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.73 / $26.73 / $36.86
| Facility | | $26.73 | $26.73 | $36.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.73 / $26.73 / $36.86
| Facility | | $26.73 | $26.73 | $36.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.73 / $26.73 / $36.86
| Facility | | $26.73 | $26.73 | $36.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $60.35 / $143.88
| Facility | | $60.00 | $60.35 | $143.88 |