- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.61 / $28.61 / $28.61
| Facility | | $28.61 | $28.61 | $28.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.85 / $28.61 / $38.27
| Professional | | $16.85 | $28.61 | $38.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.09 / $57.40 / $104.22
| Facility | | $51.09 | $57.40 | $104.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.52 / $27.52 / $29.72
| Professional | | $27.52 | $27.52 | $29.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.84 / $33.84 / $33.84
| Facility | | $33.84 | $33.84 | $33.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.70 / $24.70 / $53.81
| Professional | | $24.70 | $24.70 | $53.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.54 / $25.18 / $64.28
| Facility | | $14.54 | $25.18 | $64.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $14.54 / $14.54
| Professional | | $14.54 | $14.54 | $14.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.32 / $63.86 / $101.16
| Professional | | $38.32 | $63.86 | $101.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.46 / $22.53 / $33.94
| Professional | | $20.46 | $22.53 | $33.94 |