- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.24 / $33.93 / $33.93
| Professional | | $27.24 | $33.93 | $33.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.12 / $73.48 / $80.56
| Professional | | $61.12 | $73.48 | $80.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $61.63 / $106.21
| Professional | | $22.85 | $61.63 | $106.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.35 / $43.95 / $181.68
| Professional | | $23.35 | $43.95 | $181.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.35 / $37.15 / $55.50
| Professional | | $23.35 | $37.15 | $55.50 |