- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.11 / $39.04 / $39.04
| Professional | | $28.11 | $39.04 | $39.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.22 / $74.13 / $137.41
| Facility | | $57.22 | $74.13 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $37.56 / $37.56
| Professional | | $34.47 | $37.56 | $37.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.78 / $36.78 / $36.78
| Facility | | $36.78 | $36.78 | $36.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.85 / $26.85 / $36.78
| Professional | | $26.85 | $26.85 | $36.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.09 / $52.09 / $52.09
| Professional | | $52.09 | $52.09 | $52.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.21 / $39.04 / $39.04
| Professional | | $36.21 | $39.04 | $39.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $32.09 / $73.81
| Professional | | $22.63 | $32.09 | $73.81 |