- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $77.62 / $478.63
| Facility | | $7.41 | $77.62 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $239.88 / $309.03 / $501.19
| Facility | 25 | $239.88 | $309.03 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $186.21
| Facility | | $107.15 | $151.36 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $21.88 / $26.30
| Professional | | $21.88 | $21.88 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $31.62 / $67.61
| Facility | | $11.22 | $31.62 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |