- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.61 / $251.45 / $314.83
| Facility | | $29.61 | $251.45 | $314.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.61 / $30.90 / $36.83
| Professional | | $28.61 | $30.90 | $36.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.95 / $38.88 / $59.47
| Professional | | $29.95 | $38.88 | $59.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.21 / $35.89 / $58.53
| Facility | | $26.21 | $35.89 | $58.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.46 / $31.46 / $37.44
| Professional | | $31.46 | $31.46 | $37.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.52 / $38.25 / $55.12
| Professional | | $31.52 | $38.25 | $55.12 |