- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.75 / $28.75 / $46.08
| Facility | | $28.75 | $28.75 | $46.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $34.13 / $37.86
| Professional | | $16.23 | $34.13 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.22 / $51.22 / $51.22
| Professional | | $51.22 | $51.22 | $51.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $26.81 / $78.08
| Professional | | $9.58 | $26.81 | $78.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.68 / $28.57 / $60.77
| Professional | | $15.68 | $28.57 | $60.77 |