- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.40 / $23.78 / $49.61
| Professional | | $22.40 | $23.78 | $49.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.69 / $27.43 / $29.90
| Professional | | $24.69 | $27.43 | $29.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.42 / $36.81 / $75.40
| Professional | | $21.42 | $36.81 | $75.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.42 / $21.44 / $56.06
| Professional | | $17.42 | $21.44 | $56.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.43 / $52.54 / $72.54
| Professional | | $21.43 | $52.54 | $72.54 |