- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.25 / $36.40 / $52.02
| Professional | | $30.25 | $36.40 | $52.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $46.88 / $84.35
| Professional | | $25.80 | $46.88 | $84.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $47.37 / $65.65
| Professional | | $45.31 | $47.37 | $65.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.83 / $41.32 / $68.16
| Professional | | $32.83 | $41.32 | $68.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $34.08 / $73.70
| Professional | | $21.82 | $34.08 | $73.70 |