- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $43.87
| Facility | | $17.05 | $17.05 | $43.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $29.16 / $32.07
| Professional | | $17.05 | $29.16 | $32.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $49.11 / $54.83
| Professional | | $36.69 | $49.11 | $54.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.08 / $28.36 / $35.67
| Professional | | $28.08 | $28.36 | $35.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $36.56 / $144.75
| Facility | | $17.05 | $36.56 | $144.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $29.24 / $41.79
| Professional | | $12.08 | $29.24 | $41.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.24 / $17.05 / $41.79
| Professional | | $10.24 | $17.05 | $41.79 |