- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.18 / $31.43 / $44.57
| Professional | | $26.18 | $31.43 | $44.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.02 / $48.50 / $57.93
| Professional | | $30.02 | $48.50 | $57.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $32.45 / $89.24
| Professional | | $22.77 | $32.45 | $89.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.03 / $21.03 / $42.16
| Professional | | $21.03 | $21.03 | $42.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.92 / $36.27 / $76.83
| Professional | | $21.92 | $36.27 | $76.83 |