- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.86 / $36.86 / $52.02
| Professional | | $32.86 | $36.86 | $52.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.62 / $57.62 / $67.93
| Professional | | $57.62 | $57.62 | $67.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.78 / $40.03 / $53.04
| Professional | | $33.78 | $40.03 | $53.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.96 / $45.80 / $65.00
| Professional | | $35.96 | $45.80 | $65.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.37 / $50.37 / $85.52
| Professional | | $30.37 | $50.37 | $85.52 |