- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $70.79 / $95.50
| Professional | | $52.48 | $70.79 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Professional | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $67.61 / $104.71
| Professional | | $33.88 | $67.61 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $57.54 / $70.79
| Professional | | $34.67 | $57.54 | $70.79 |