- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.22 / $36.22 / $87.34
| Professional | | $35.22 | $36.22 | $87.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.77 / $42.34 / $53.92
| Professional | | $28.77 | $42.34 | $53.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $28.82 / $39.23
| Professional | | $22.14 | $28.82 | $39.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.17 / $48.54 / $59.37
| Professional | | $39.17 | $48.54 | $59.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.84 / $28.44 / $56.88
| Professional | | $25.84 | $28.44 | $56.88 |