- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.15 / $32.90 / $35.50
| Professional | | $26.15 | $32.90 | $35.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.63 / $114.27 / $135.29
| Facility | | $84.63 | $114.27 | $135.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.42 / $50.86 / $52.60
| Professional | | $48.42 | $50.86 | $52.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.72 / $36.72 / $36.72
| Facility | | $36.72 | $36.72 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.81 / $36.72 / $36.72
| Professional | | $26.81 | $36.72 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.38 / $31.88 / $49.76
| Professional | | $23.38 | $31.88 | $49.76 |