- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.88 / $49.54 / $61.86
| Professional | | $27.88 | $49.54 | $61.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.44 / $47.08 / $113.80
| Professional | | $26.44 | $47.08 | $113.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $36.64 / $51.35
| Professional | | $25.65 | $36.64 | $51.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.29 / $42.58 / $120.08
| Professional | | $25.29 | $42.58 | $120.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $32.67 / $70.17
| Professional | | $16.64 | $32.67 | $70.17 |