- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.06 / $38.61 / $54.94
| Professional | | $27.06 | $38.61 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.57 / $51.01 / $85.85
| Professional | | $29.57 | $51.01 | $85.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.29 / $71.43 / $108.70
| Professional | | $33.29 | $71.43 | $108.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.33 / $62.58 / $108.39
| Professional | | $31.33 | $62.58 | $108.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.06 / $38.61 / $54.94
| Professional | | $27.06 | $38.61 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.87 / $68.42 / $117.24
| Professional | | $44.87 | $68.42 | $117.24 |