- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.58 / $31.93 / $40.36
| Professional | | $24.58 | $31.93 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $26.82 / $43.84
| Professional | | $17.00 | $26.82 | $43.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.21 / $35.79 / $56.34
| Professional | | $23.21 | $35.79 | $56.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $35.58 / $203.39
| Professional | | $20.00 | $35.58 | $203.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.95 / $34.14 / $62.19
| Professional | | $21.95 | $34.14 | $62.19 |