- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $128.82
| Professional | | $30.20 | $47.86 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $30.20 / $37.15
| Professional | | $27.54 | $30.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $56.23 / $109.65
| Professional | | $33.88 | $56.23 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $72.44 / $107.15
| Professional | | $63.10 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $48.98 / $89.13
| Professional | | $29.51 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $72.44 / $89.13
| Professional | | $45.71 | $72.44 | $89.13 |