- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.73 / $55.06 / $73.41
| Professional | | $28.73 | $55.06 | $73.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.73 / $58.73 / $58.73
| Professional | | $58.73 | $58.73 | $58.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.18 / $30.18 / $30.18
| Professional | | $30.18 | $30.18 | $30.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.26 / $86.36 / $125.76
| Professional | | $71.26 | $86.36 | $125.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.37 / $41.83 / $53.56
| Professional | | $31.37 | $41.83 | $53.56 |