- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $35.58 / $50.52
| Professional | | $31.67 | $35.58 | $50.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.84 / $46.55 / $92.49
| Professional | | $26.84 | $46.55 | $92.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $57.90 / $69.26
| Professional | | $45.85 | $57.90 | $69.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.57 / $65.23 / $85.26
| Professional | | $53.57 | $65.23 | $85.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $33.82 / $58.17
| Professional | | $15.51 | $33.82 | $58.17 |