- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $37.15 / $46.77
| Professional | | $32.36 | $37.15 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $41.69
| Facility | | $20.42 | $20.42 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $22.39 / $44.67
| Facility | | $20.42 | $22.39 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | | $35.48 | $35.48 | $35.48 |