- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.85 / $17.89 / $69.33
| Professional | | $17.85 | $17.89 | $69.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.87 / $27.87 / $60.31
| Facility | | $15.87 | $27.87 | $60.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $27.87 / $32.03
| Professional | | $19.64 | $27.87 | $32.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.22 / $22.46 / $34.15
| Facility | | $15.22 | $22.46 | $34.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.88 / $27.50 / $44.12
| Professional | | $17.88 | $27.50 | $44.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.03 / $31.27 / $37.11
| Professional | | $27.03 | $31.27 | $37.11 |