- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.71 / $33.15 / $48.87
| Professional | | $21.71 | $33.15 | $48.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.64 / $61.64 / $72.66
| Professional | | $61.64 | $61.64 | $72.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.48 / $33.33 / $55.58
| Professional | | $18.48 | $33.33 | $55.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.76 / $37.33 / $59.70
| Professional | | $21.76 | $37.33 | $59.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.79 / $55.16 / $63.57
| Professional | | $35.79 | $55.16 | $63.57 |