- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.55 / $19.43 / $26.23
| Professional | | $14.55 | $19.43 | $26.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.52 / $26.51 / $42.06
| Professional | | $19.52 | $26.51 | $42.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.03 / $37.03 / $37.03
| Facility | | $37.03 | $37.03 | $37.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.41 / $27.88 / $36.22
| Professional | | $20.41 | $27.88 | $36.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.06 / $198.13 / $258.23
| Professional | | $146.06 | $198.13 | $258.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.68 / $30.08 / $40.15
| Professional | | $24.68 | $30.08 | $40.15 |