- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.48 / $417.31 / $987.71
| Facility | | $98.48 | $417.31 | $987.71 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $140.21 / $847.87 / $987.71
| Facility | 25 | $140.21 | $847.87 | $987.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.66 / $111.66 / $111.66
| Facility | | $111.66 | $111.66 | $111.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.37 / $122.52 / $434.96
| Professional | | $82.37 | $122.52 | $434.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.99 / $160.78 / $240.76
| Facility | | $107.99 | $160.78 | $240.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.46 / $160.27 / $313.70
| Facility | | $109.46 | $160.27 | $313.70 |