- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.84 / $301.23 / $692.76
| Facility | | $42.84 | $301.23 | $692.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.70 / $28.70 / $35.56
| Professional | | $28.70 | $28.70 | $35.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.85 / $27.85 / $27.85
| Facility | | $27.85 | $27.85 | $27.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $34.61 / $85.94
| Professional | | $30.72 | $34.61 | $85.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.84 / $105.06 / $275.48
| Facility | | $42.84 | $105.06 | $275.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $25.70 / $94.25
| Professional | | $17.98 | $25.70 | $94.25 |