- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.79 / $55.79 / $65.06
| Facility | | $55.79 | $55.79 | $65.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $21.64 / $25.43
| Professional | | $20.02 | $21.64 | $25.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.19 / $29.64 / $43.21
| Facility | | $25.19 | $29.64 | $43.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $20.80 / $42.17
| Professional | | $10.82 | $20.80 | $42.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.46 / $38.20 / $44.47
| Facility | | $32.46 | $38.20 | $44.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $14.22
| Professional | | $14.22 | $14.22 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $16.23 / $35.71
| Professional | | $11.36 | $16.23 | $35.71 |