- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.95 / $160.76 / $341.32
| Facility | | $34.95 | $160.76 | $341.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.59 / $39.64 / $39.64
| Professional | | $32.59 | $39.64 | $39.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.52 / $25.52 / $25.52
| Facility | | $25.52 | $25.52 | $25.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.33 / $45.02 / $63.32
| Professional | | $24.33 | $45.02 | $63.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.43 / $172.63 / $262.56
| Facility | | $104.43 | $172.63 | $262.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $20.82 / $47.43
| Professional | | $16.48 | $20.82 | $47.43 |