- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.45 / $71.45 / $71.45
| Facility | | $71.45 | $71.45 | $71.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.41 / $71.45 / $73.73
| Professional | | $58.41 | $71.45 | $73.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.41 / $97.90 / $109.38
| Facility | | $86.41 | $97.90 | $109.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.84 / $89.92 / $118.69
| Professional | | $70.84 | $89.92 | $118.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $82.04 / $143.86
| Facility | | $10.40 | $82.04 | $143.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $86.14 / $143.86
| Professional | | $9.35 | $86.14 | $143.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.04 / $73.04 / $95.86
| Facility | | $73.04 | $73.04 | $95.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.08 / $73.04 / $140.55
| Professional | | $62.08 | $73.04 | $140.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $40.29 / $77.41
| Facility | | $4.84 | $40.29 | $77.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.52 / $56.09 / $87.52
| Professional | | $34.52 | $56.09 | $87.52 |