- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.96 / $29.96 / $29.96
| Facility | | $29.96 | $29.96 | $29.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.96 / $46.93 / $55.28
| Professional | | $29.96 | $46.93 | $55.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.47 / $65.90 / $87.99
| Facility | | $54.47 | $65.90 | $87.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.11 / $48.11 / $77.05
| Professional | | $48.11 | $48.11 | $77.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.39 / $80.95 / $115.27
| Professional | | $80.39 | $80.95 | $115.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.93 / $87.99 / $87.99
| Professional | | $85.93 | $87.99 | $87.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.51 / $43.90 / $87.99
| Professional | | $39.51 | $43.90 | $87.99 |