- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $30.20 / $52.48
| Professional | | $16.98 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $117.49 / $117.49
| Professional | | $23.44 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $47.86 / $81.28
| Professional | | $22.91 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $35.48 / $89.13
| Professional | | $17.38 | $35.48 | $89.13 |