- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.90 / $34.27 / $78.80
| Professional | | $14.90 | $34.27 | $78.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.83 / $58.24 / $123.37
| Professional | | $27.83 | $58.24 | $123.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.85 / $73.62 / $145.79
| Professional | | $33.85 | $73.62 | $145.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.52 / $69.67 / $131.01
| Professional | | $33.52 | $69.67 | $131.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.93 / $65.56 / $197.25
| Professional | | $38.93 | $65.56 | $197.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.25 / $56.20 / $129.91
| Professional | | $36.25 | $56.20 | $129.91 |