- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.22 / $36.61 / $74.50
| Professional | | $28.22 | $36.61 | $74.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.48 / $31.64 / $39.57
| Professional | | $28.48 | $31.64 | $39.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.97 / $33.47 / $61.61
| Professional | | $26.97 | $33.47 | $61.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.11 / $40.13 / $71.63
| Professional | | $31.11 | $40.13 | $71.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.81 / $32.29 / $56.56
| Professional | | $23.81 | $32.29 | $56.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.41 / $21.41 / $43.86
| Professional | | $21.41 | $21.41 | $43.86 |