- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $26.92 / $28.84
| Professional | | $20.89 | $26.92 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $24.55 / $33.88
| Professional | | $11.22 | $24.55 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $47.86 / $60.26
| Professional | | $38.90 | $47.86 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $28.18
| Facility | | $22.39 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $34.67 / $102.33
| Professional | | $16.98 | $34.67 | $102.33 |