- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $37.15 / $63.10
| Professional | | $30.20 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $27.54 / $35.48
| Professional | | $16.60 | $27.54 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Professional | | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $42.66 / $61.66
| Professional | | $27.54 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $37.15 / $75.86
| Professional | | $27.54 | $37.15 | $75.86 |