- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $63.10 / $234.42
| Facility | | $50.12 | $63.10 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $151.36
| Professional | | $61.66 | $61.66 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $131.83 / $181.97
| Facility | | $85.11 | $131.83 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $134.90 / $181.97
| Facility | | $51.29 | $134.90 | $181.97 |