- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $29.46 / $51.58
| Professional | | $29.46 | $29.46 | $51.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.53 / $57.53 / $57.53
| Facility | | $57.53 | $57.53 | $57.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.53 / $57.53 / $57.53
| Professional | | $57.53 | $57.53 | $57.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.36 / $37.36 / $70.33
| Facility | | $37.36 | $37.36 | $70.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.27 / $27.27 / $37.36
| Professional | | $27.27 | $27.27 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.05 / $28.82 / $44.41
| Professional | | $26.05 | $28.82 | $44.41 |