- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.81 / $56.36 / $65.81
| Professional | | $47.81 | $56.36 | $65.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.88 / $69.02 / $97.47
| Professional | | $56.88 | $69.02 | $97.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.18 / $58.17 / $75.03
| Professional | | $47.18 | $58.17 | $75.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.56 / $70.23 / $86.26
| Professional | | $59.56 | $70.23 | $86.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.84 / $59.60 / $106.55
| Professional | | $48.84 | $59.60 | $106.55 |