- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $114.82 / $234.42
| Facility | | $109.65 | $114.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $33.88 / $52.48
| Professional | | $28.84 | $33.88 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $44.67 / $74.13
| Facility | | $41.69 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.42 / $61.66
| Professional | | $17.38 | $20.42 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $87.10 / $154.88
| Facility | | $33.88 | $87.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $28.18 / $52.48
| Professional | | $26.30 | $28.18 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $36.31 / $72.44
| Professional | | $20.89 | $36.31 | $72.44 |