- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.15 / $31.58 / $36.74
| Professional | | $24.15 | $31.58 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.63 / $55.95 / $71.94
| Professional | | $50.63 | $55.95 | $71.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.28 / $28.82 / $59.76
| Professional | | $18.28 | $28.82 | $59.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.17 / $32.43 / $39.52
| Professional | | $26.17 | $32.43 | $39.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $33.77 / $48.25
| Professional | | $27.05 | $33.77 | $48.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.63 / $30.56 / $41.54
| Professional | | $20.63 | $30.56 | $41.54 |