- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.78 / $32.92 / $64.25
| Professional | | $27.78 | $32.92 | $64.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.72 / $47.01 / $54.65
| Professional | | $43.72 | $47.01 | $54.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.00 / $62.00 / $62.00
| Professional | | $62.00 | $62.00 | $62.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.02 / $73.00 / $104.57
| Professional | | $45.02 | $73.00 | $104.57 |
- 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
- $43.37 / $51.09 / $57.00
| Professional | | $43.37 | $51.09 | $57.00 |