- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.63 / $50.87 / $67.83
| Professional | | $27.63 | $50.87 | $67.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $61.49 / $75.67
| Professional | | $48.00 | $61.49 | $75.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.18 / $30.18 / $30.18
| Professional | | $30.18 | $30.18 | $30.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.02 / $52.31 / $73.41
| Facility | | $42.02 | $52.31 | $73.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.56 / $29.53 / $35.44
| Professional | | $24.56 | $29.53 | $35.44 |