- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.51 / $67.25 / $152.82
| Facility | | $54.51 | $67.25 | $152.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.75 / $42.28 / $49.51
| Professional | | $40.75 | $42.28 | $49.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Facility | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Professional | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.92 / $46.35 / $69.56
| Facility | | $36.92 | $46.35 | $69.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.53 / $40.53 / $227.88
| Professional | | $40.53 | $40.53 | $227.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.53 / $40.53 / $42.96
| Professional | | $40.53 | $40.53 | $42.96 |