- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.88 / $51.29
| Professional | | $25.70 | $33.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $56.23 / $97.72
| Professional | | $40.74 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $47.86 / $109.65
| Professional | | $17.78 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $48.98 / $102.33
| Professional | | $32.36 | $48.98 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $42.66 / $77.62
| Professional | | $20.89 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |