- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.84 / $35.79 / $46.40
| Professional | | $20.84 | $35.79 | $46.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.77 / $47.77 / $47.77
| Facility | | $47.77 | $47.77 | $47.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.77 / $47.77 / $47.77
| Professional | | $47.77 | $47.77 | $47.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.63 / $38.63 / $58.23
| Facility | | $38.63 | $38.63 | $58.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.84 / $38.63 / $46.31
| Professional | | $32.84 | $38.63 | $46.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.62 / $29.55 / $60.57
| Professional | | $19.62 | $29.55 | $60.57 |