- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.79 / $89.74 / $156.60
| Facility | | $47.79 | $89.74 | $156.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.57 / $37.78 / $43.43
| Professional | | $32.57 | $37.78 | $43.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.29 / $54.29 / $54.29
| Professional | | $54.29 | $54.29 | $54.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.39 / $71.14 / $98.35
| Facility | | $38.39 | $71.14 | $98.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.74 / $43.43 / $58.43
| Facility | | $34.74 | $43.43 | $58.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.06 / $216.28
| Professional | | $18.23 | $26.06 | $216.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.06 / $90.37
| Professional | | $18.23 | $26.06 | $90.37 |