- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.09 / $34.47 / $42.75
| Professional | | $28.09 | $34.47 | $42.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.26 / $32.35 / $48.14
| Professional | | $27.26 | $32.35 | $48.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $37.94 / $43.30 / $48.11
| Professional | 50 | $37.94 | $43.30 | $48.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.72 / $38.59 / $50.75
| Professional | | $27.72 | $38.59 | $50.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.30 / $36.33 / $57.02
| Professional | | $0.30 | $36.33 | $57.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.51 / $39.22 / $62.54
| Professional | | $32.51 | $39.22 | $62.54 |