- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.43 / $30.85 / $68.80
| Professional | | $28.43 | $30.85 | $68.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $22.75 / $30.26
| Professional | | $22.75 | $22.75 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.79 / $49.73 / $135.24
| Professional | | $33.79 | $49.73 | $135.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.34 / $39.64 / $72.97
| Professional | | $33.34 | $39.64 | $72.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.71 / $38.34 / $92.41
| Professional | | $29.71 | $38.34 | $92.41 |