- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $40.25 / $51.22
| Professional | | $29.38 | $40.25 | $51.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.67 / $114.14 / $207.62
| Professional | | $63.67 | $114.14 | $207.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.52 / $59.38 / $71.76
| Professional | | $54.52 | $59.38 | $71.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.42 / $53.98 / $56.51
| Professional | | $51.42 | $53.98 | $56.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $52.52 / $130.76
| Professional | | $30.37 | $52.52 | $130.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.79 / $51.81 / $112.34
| Professional | | $30.79 | $51.81 | $112.34 |