- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $72.44 / $173.78
| Professional | | $26.92 | $72.44 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $56.23 / $81.28
| Professional | | $21.38 | $56.23 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $53.70 / $134.90
| Professional | | $18.20 | $53.70 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $67.61 / $138.04
| Professional | | $34.67 | $67.61 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $56.23 / $109.65
| Professional | | $30.90 | $56.23 | $109.65 |