- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $30.03 / $37.54
| Professional | | $19.00 | $30.03 | $37.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.83 / $90.00 / $90.00
| Facility | | $29.83 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.00 / $31.00 / $31.00
| Professional | | $31.00 | $31.00 | $31.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.69 / $14.69 / $20.55
| Facility | | $14.69 | $14.69 | $20.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.55 / $28.00 / $35.17
| Professional | | $20.55 | $28.00 | $35.17 |