- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.38 / $84.49 / $373.31
| Facility | | $50.38 | $84.49 | $373.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.38 / $50.38 / $50.38
| Professional | | $50.38 | $50.38 | $50.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.50 / $25.50 / $48.96
| Professional | | $25.50 | $25.50 | $48.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.31 / $46.04 / $78.41
| Facility | | $35.31 | $46.04 | $78.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.31 / $46.04 / $123.11
| Facility | | $35.31 | $46.04 | $123.11 |