- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $34.67 / $41.69
| Professional | | $26.92 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $72.44
| Professional | | $32.36 | $40.74 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $36.31 / $46.77
| Professional | | $14.45 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $32.36 / $234.42
| Professional | | $23.44 | $32.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $31.62 / $40.74
| Professional | | $23.44 | $31.62 | $40.74 |