- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $28.24 / $39.45
| Professional | | $22.07 | $28.24 | $39.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.73 / $40.14 / $51.81
| Professional | | $25.73 | $40.14 | $51.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.57 / $33.24 / $79.81
| Professional | | $19.57 | $33.24 | $79.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.54 / $21.54 / $37.44
| Professional | | $21.54 | $21.54 | $37.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.51 / $32.92 / $69.84
| Professional | | $18.51 | $32.92 | $69.84 |