- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.67 / $26.87 / $35.47
| Professional | | $25.67 | $26.87 | $35.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.22 / $46.00 / $48.30
| Professional | | $31.22 | $46.00 | $48.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.22 / $19.67 / $56.08
| Professional | | $17.22 | $19.67 | $56.08 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.50 / $44.73 / $44.99
| Facility | 26 | $42.50 | $44.73 | $44.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.49 / $34.36 / $48.85
| Professional | | $27.49 | $34.36 | $48.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $24.12 / $76.13
| Professional | | $19.77 | $24.12 | $76.13 |