- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $38.02 / $46.77
| Professional | | $26.92 | $38.02 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $72.44 / $112.20
| Professional | | $40.74 | $72.44 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $60.26 / $123.03
| Professional | | $33.11 | $60.26 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $47.86 / $107.15
| Professional | | $21.38 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |