- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.10 / $28.87 / $50.20
| Facility | | $25.10 | $28.87 | $50.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.82 / $28.87 / $28.87
| Professional | | $18.82 | $28.87 | $28.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.12 / $19.57 / $26.32
| Facility | | $16.12 | $19.57 | $26.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.29 / $25.60 / $30.21
| Professional | | $16.29 | $25.60 | $30.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.73 / $20.39 / $54.35
| Facility | | $17.73 | $20.39 | $54.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $15.60
| Professional | | $10.54 | $10.54 | $15.60 |