- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $28.07 / $79.19
| Facility | | $28.07 | $28.07 | $79.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.33 / $28.07 / $29.83
| Professional | | $23.33 | $28.07 | $29.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.66 / $48.65 / $92.52
| Facility | | $26.66 | $48.65 | $92.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $35.09 / $52.64
| Facility | | $28.07 | $35.09 | $52.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.81 / $22.81 / $35.09
| Professional | | $22.81 | $22.81 | $35.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $21.05 / $38.60
| Professional | | $17.55 | $21.05 | $38.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.06 / $166.68 / $166.68
| Facility | | $61.06 | $166.68 | $166.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.45 / $175.45 / $263.18
| Professional | | $175.45 | $175.45 | $263.18 |