- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.26 / $34.32 / $44.91
| Professional | | $29.26 | $34.32 | $44.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.73 / $31.03 / $48.13
| Professional | | $23.73 | $31.03 | $48.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.93 / $36.40 / $107.16
| Professional | | $19.93 | $36.40 | $107.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.75 / $233.75 / $337.80
| Professional | | $233.75 | $233.75 | $337.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $31.65 / $56.97
| Professional | | $21.44 | $31.65 | $56.97 |