- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.88 / $41.69
| Professional | | $25.70 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $35.48 / $40.74
| Professional | | $28.84 | $35.48 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $33.88 / $61.66
| Professional | | $20.89 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $33.88 / $234.42
| Professional | | $21.38 | $33.88 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $30.20 / $45.71
| Professional | | $19.95 | $30.20 | $45.71 |