- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.63 / $43.36 / $53.44
| Professional | | $29.63 | $43.36 | $53.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.25 / $44.71 / $51.03
| Professional | | $33.25 | $44.71 | $51.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.75 / $45.11 / $62.43
| Professional | | $33.75 | $45.11 | $62.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $44.49 / $325.73
| Professional | | $30.37 | $44.49 | $325.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.58 / $39.14 / $58.24
| Professional | | $28.58 | $39.14 | $58.24 |