- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $36.72 / $131.40
| Professional | | $21.73 | $36.72 | $131.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.11 / $42.48 / $52.34
| Professional | | $38.11 | $42.48 | $52.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.68 / $47.44 / $324.60
| Professional | | $24.68 | $47.44 | $324.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.93 / $48.66 / $62.07
| Professional | | $29.93 | $48.66 | $62.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.88 / $34.04 / $42.47
| Professional | | $25.88 | $34.04 | $42.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.68 / $44.78 / $55.31
| Professional | | $24.68 | $44.78 | $55.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $41.60 / $49.00
| Professional | | $40.00 | $41.60 | $49.00 |