- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.74 / $53.28 / $67.22
| Professional | | $39.74 | $53.28 | $67.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.65 / $49.70 / $76.31
| Professional | | $35.65 | $49.70 | $76.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.22 / $58.45 / $95.50
| Professional | | $38.22 | $58.45 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.36 / $56.59 / $322.74
| Professional | | $34.36 | $56.59 | $322.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $56.59 / $115.35
| Professional | | $36.40 | $56.59 | $115.35 |