- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.49 / $213.75 / $224.58
| Facility | | $38.49 | $213.75 | $224.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.42 / $22.42 / $27.78
| Professional | | $22.42 | $22.42 | $27.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.76 / $21.76 / $21.76
| Facility | | $21.76 | $21.76 | $21.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.94 / $20.26 / $50.52
| Professional | | $17.94 | $20.26 | $50.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.76 / $141.76 / $141.76
| Facility | | $141.76 | $141.76 | $141.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.41 / $26.78 / $73.63
| Professional | | $18.41 | $26.78 | $73.63 |