- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.15 / $99.81 / $336.52
| Facility | | $25.15 | $99.81 | $336.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.02 / $87.35 / $129.05
| Professional | | $74.02 | $87.35 | $129.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.05 / $139.16 / $205.56
| Facility | | $102.05 | $139.16 | $205.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.52 / $166.52 / $166.52
| Professional | | $166.52 | $166.52 | $166.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.12 / $87.12 / $87.12
| Professional | | $87.12 | $87.12 | $87.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.38 / $103.38 / $103.38
| Facility | | $103.38 | $103.38 | $103.38 |