- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.17 / $34.92 / $53.08
| Professional | | $18.17 | $34.92 | $53.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.56 / $27.29 / $31.38
| Professional | | $24.56 | $27.29 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.00 / $48.00 / $105.00
| Professional | | $34.00 | $48.00 | $105.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $36.93 / $95.76
| Professional | | $19.64 | $36.93 | $95.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.68 / $49.11 / $121.27
| Professional | | $38.68 | $49.11 | $121.27 |