- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.56 / $47.20 / $58.52
| Professional | | $37.56 | $47.20 | $58.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.20 / $63.89 / $200.11
| Professional | | $54.20 | $63.89 | $200.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $63.68 / $109.94
| Professional | | $33.61 | $63.68 | $109.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $57.58 / $90.62
| Professional | | $37.04 | $57.58 | $90.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.97 / $54.25 / $200.73
| Professional | | $41.97 | $54.25 | $200.73 |