- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $36.86 / $52.75
| Professional | | $27.86 | $36.86 | $52.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.76 / $50.63 / $82.09
| Professional | | $38.76 | $50.63 | $82.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $48.65 / $118.92
| Professional | | $26.52 | $48.65 | $118.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.21 / $56.06 / $141.37
| Professional | | $36.21 | $56.06 | $141.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $40.96 / $95.67
| Professional | | $22.77 | $40.96 | $95.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.52 / $32.47 / $41.33
| Professional | | $29.52 | $32.47 | $41.33 |