- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.38 / $35.40 / $45.58
| Professional | | $30.38 | $35.40 | $45.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.39 / $54.68 / $83.54
| Professional | | $46.39 | $54.68 | $83.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.64 / $36.84 / $55.33
| Professional | | $27.64 | $36.84 | $55.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.10 / $38.51 / $60.74
| Professional | | $30.10 | $38.51 | $60.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.49 / $41.89 / $56.84
| Professional | | $24.49 | $41.89 | $56.84 |