- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.91 / $38.61 / $92.82
| Professional | | $28.91 | $38.61 | $92.82 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $109.64 / $158.38 / $260.77
| Professional | 50 | $109.64 | $158.38 | $260.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $29.13 / $52.22
| Professional | | $29.13 | $29.13 | $52.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.19 / $35.85 / $62.71
| Professional | | $25.19 | $35.85 | $62.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.83 / $42.16 / $58.44
| Professional | | $34.83 | $42.16 | $58.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.92 / $32.95 / $46.58
| Professional | | $27.92 | $32.95 | $46.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.59 / $33.95 / $38.96
| Professional | | $31.59 | $33.95 | $38.96 |