- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.37 / $29.92 / $40.65
| Professional | | $24.37 | $29.92 | $40.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.64 / $39.64 / $39.64
| Professional | | $39.64 | $39.64 | $39.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.90 / $37.90 / $37.90
| Facility | | $37.90 | $37.90 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.22 / $32.22 / $39.04
| Professional | | $32.22 | $32.22 | $39.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.57 / $52.16 / $62.59
| Professional | | $40.57 | $52.16 | $62.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.73 / $29.30 / $47.70
| Professional | | $24.73 | $29.30 | $47.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.72 / $38.72 / $49.26
| Professional | | $38.72 | $38.72 | $49.26 |