- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $60.26 / $60.26
| Facility | | $48.98 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.85 / $35.48
| Professional | | $10.96 | $15.85 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $10.72 / $14.13
| Facility | | $8.32 | $10.72 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $10.23 / $17.38
| Professional | | $6.61 | $10.23 | $17.38 |