- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.48 / $55.78 / $78.06
| Professional | | $30.48 | $55.78 | $78.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.53 / $65.53 / $65.53
| Professional | | $65.53 | $65.53 | $65.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.09 / $101.08 / $106.97
| Professional | | $89.09 | $101.08 | $106.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.18 / $37.01 / $48.27
| Professional | | $32.18 | $37.01 | $48.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.86 / $56.49 / $93.40
| Professional | | $32.86 | $56.49 | $93.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.18 / $32.18 / $37.01
| Professional | | $32.18 | $32.18 | $37.01 |