- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.12 / $32.18 / $52.58
| Professional | | $18.12 | $32.18 | $52.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $34.68 / $64.88
| Professional | | $18.14 | $34.68 | $64.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.18 / $47.86 / $74.52
| Professional | | $26.18 | $47.86 | $74.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.41 / $36.68 / $56.45
| Professional | | $27.41 | $36.68 | $56.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $46.45 / $83.81
| Professional | | $28.87 | $46.45 | $83.81 |