- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.56 / $33.02 / $40.61
| Professional | | $20.56 | $33.02 | $40.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.17 / $62.09 / $114.34
| Professional | | $29.17 | $62.09 | $114.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.36 / $56.50 / $67.18
| Professional | | $46.36 | $56.50 | $67.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.12 / $47.96 / $53.13
| Professional | | $43.12 | $47.96 | $53.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.38 / $38.65 / $42.95
| Professional | | $30.38 | $38.65 | $42.95 |