- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.79 / $763.68 / $982.08
| Facility | | $624.79 | $763.68 | $982.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.23 / $16.80 / $310.39
| Professional | | $0.23 | $16.80 | $310.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $2.87 / $2.87
| Professional | | $2.87 | $2.87 | $2.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.65 / $369.82 / $760.63
| Facility | | $13.65 | $369.82 | $760.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.68 / $45.68 / $263.02
| Professional | | $45.68 | $45.68 | $263.02 |