- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.25 / $36.72 / $140.16
| Facility | | $28.25 | $36.72 | $140.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $29.58 / $34.65
| Professional | | $22.65 | $29.58 | $34.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.26 / $49.89 / $84.96
| Facility | | $28.26 | $49.89 | $84.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.50 / $29.32 / $36.77
| Professional | | $20.50 | $29.32 | $36.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.65 / $26.65 / $40.00
| Facility | | $26.65 | $26.65 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.32 / $53.04 / $151.88
| Facility | | $17.32 | $53.04 | $151.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $16.44 / $38.20
| Professional | | $12.61 | $16.44 | $38.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $12.60 / $34.36
| Professional | | $11.19 | $12.60 | $34.36 |