- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $25.04 / $45.55
| Professional | | $17.14 | $25.04 | $45.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $36.74
| Facility | | $36.74 | $36.74 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.23 / $36.74 / $64.88
| Professional | | $31.23 | $36.74 | $64.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.12 / $51.12 / $51.47
| Professional | | $51.12 | $51.12 | $51.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.82 / $36.82 / $36.82
| Professional | | $36.82 | $36.82 | $36.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.38 / $30.48 / $50.82
| Professional | | $22.38 | $30.48 | $50.82 |