- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.38 / $70.55 / $108.23
| Facility | | $60.38 | $70.55 | $108.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.67 / $34.59 / $161.04
| Professional | | $27.67 | $34.59 | $161.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.70 / $15.70 / $21.64
| Facility | | $15.70 | $15.70 | $21.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.70 / $15.70 / $21.64
| Facility | | $15.70 | $15.70 | $21.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.70 / $15.70 / $21.64
| Facility | | $15.70 | $15.70 | $21.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $100.00
| Facility | | $60.00 | $60.00 | $100.00 |