- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.24 / $36.86 / $52.75
| Professional | | $29.24 | $36.86 | $52.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $55.74 / $71.28
| Professional | | $34.32 | $55.74 | $71.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $37.79 / $109.81
| Professional | | $25.61 | $37.79 | $109.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.50 / $24.50 / $53.58
| Professional | | $24.50 | $24.50 | $53.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.87 / $45.06 / $108.66
| Professional | | $23.87 | $45.06 | $108.66 |