- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.66 / $47.67 / $64.30
| Professional | | $19.66 | $47.67 | $64.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.61 / $28.61 / $28.61
| Professional | | $28.61 | $28.61 | $28.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.72 / $75.13 / $92.21
| Professional | | $71.72 | $75.13 | $92.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.66 / $55.66 / $55.66
| Professional | | $55.66 | $55.66 | $55.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $35.83 / $40.98
| Professional | | $29.74 | $35.83 | $40.98 |