- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.86 / $39.47 / $52.85
| Professional | | $32.86 | $39.47 | $52.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.76 / $33.25 / $61.19
| Professional | | $26.76 | $33.25 | $61.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.26 / $33.57 / $58.71
| Professional | | $16.26 | $33.57 | $58.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.35 / $50.35 / $80.88
| Professional | | $0.35 | $50.35 | $80.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.87 / $39.44 / $74.38
| Professional | | $23.87 | $39.44 | $74.38 |