- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $34.67 / $43.65
| Professional | | $28.18 | $34.67 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $14.13 / $24.55
| Professional | | $12.59 | $14.13 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $42.66 / $117.49
| Professional | | $19.95 | $42.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $75.86
| Professional | | $47.86 | $47.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $30.90 / $109.65
| Professional | | $12.02 | $30.90 | $109.65 |