- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $45.71 / $107.15
| Professional | | $33.88 | $45.71 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $47.86 / $69.18
| Professional | | $43.65 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $47.86 / $81.28
| Professional | | $34.67 | $47.86 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $56.23 / $74.13
| Professional | | $41.69 | $56.23 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $43.65 / $75.86
| Professional | | $31.62 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $61.66 / $75.86
| Professional | | $30.90 | $61.66 | $75.86 |