- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.67 / $31.68 / $32.78
| Professional | | $22.67 | $31.68 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.22 / $66.13 / $105.18
| Professional | | $34.22 | $66.13 | $105.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.75 / $86.59 / $125.88
| Professional | | $65.75 | $86.59 | $125.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.67 / $76.90 / $137.01
| Professional | | $39.67 | $76.90 | $137.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.46 / $62.68 / $118.04
| Professional | | $43.46 | $62.68 | $118.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.20 / $29.57 / $42.40
| Professional | | $22.20 | $29.57 | $42.40 |