- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $43.51 / $60.46
| Professional | | $32.28 | $43.51 | $60.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.08 / $49.75 / $76.80
| Professional | | $40.08 | $49.75 | $76.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $29.98 / $38.81
| Professional | | $23.65 | $29.98 | $38.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.21 / $67.00 / $79.31
| Professional | | $52.21 | $67.00 | $79.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.68 / $42.28 / $60.01
| Professional | | $31.68 | $42.28 | $60.01 |