- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $33.20 / $109.15
| Professional | | $21.05 | $33.20 | $109.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.56 / $32.76 / $44.28
| Professional | | $28.56 | $32.76 | $44.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.38 / $30.12 / $45.28
| Professional | | $20.38 | $30.12 | $45.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.20 / $29.38 / $128.41
| Professional | | $20.20 | $29.38 | $128.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.87 / $24.21 / $26.10
| Professional | | $23.87 | $24.21 | $26.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.09 / $28.74 / $45.32
| Professional | | $20.09 | $28.74 | $45.32 |