- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $31.67 / $39.45
| Professional | | $21.94 | $31.67 | $39.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.83 / $87.26 / $109.10
| Professional | | $50.83 | $87.26 | $109.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.94 / $78.54 / $126.13
| Professional | | $34.94 | $78.54 | $126.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.70 / $76.55 / $110.48
| Professional | | $44.70 | $76.55 | $110.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.32 / $40.67 / $100.90
| Professional | | $23.32 | $40.67 | $100.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.66 / $43.89 / $100.72
| Professional | | $23.66 | $43.89 | $100.72 |