- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.74 / $27.74 / $43.37
| Professional | | $27.74 | $27.74 | $43.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.37 / $48.37 / $48.37
| Facility | | $48.37 | $48.37 | $48.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.37 / $48.37 / $48.37
| Professional | | $48.37 | $48.37 | $48.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.72 / $33.72 / $53.66
| Facility | | $33.72 | $33.72 | $53.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.62 / $24.62 / $33.72
| Professional | | $24.62 | $24.62 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.76 / $21.86 / $24.26
| Professional | | $19.76 | $21.86 | $24.26 |