- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.63 / $37.42 / $73.98
| Professional | | $29.63 | $37.42 | $73.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.76 / $66.78 / $66.78
| Professional | | $56.76 | $66.78 | $66.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.45 / $49.58 / $130.15
| Professional | | $36.45 | $49.58 | $130.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.60 / $75.22 / $105.41
| Professional | | $41.60 | $75.22 | $105.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.51 / $56.43 / $67.89
| Professional | | $48.51 | $56.43 | $67.89 |