- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.51 / $29.25 / $43.03
| Professional | | $20.51 | $29.25 | $43.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.37 / $82.76 / $118.94
| Professional | | $66.37 | $82.76 | $118.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $29.37 / $37.72
| Professional | | $23.65 | $29.37 | $37.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.79 / $54.11 / $69.12
| Professional | | $36.79 | $54.11 | $69.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.48 / $29.66 / $44.02
| Professional | | $20.48 | $29.66 | $44.02 |