- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.20 / $42.75 / $63.16
| Professional | | $35.20 | $42.75 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.35 / $59.65 / $77.29
| Professional | | $35.35 | $59.65 | $77.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.26 / $54.40 / $106.88
| Professional | | $40.26 | $54.40 | $106.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.72 / $39.72 / $50.57
| Professional | | $39.72 | $39.72 | $50.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.47 / $53.82 / $106.97
| Professional | | $36.47 | $53.82 | $106.97 |