- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.37 / $26.94 / $39.45
| Professional | | $19.37 | $26.94 | $39.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $32.46 / $58.63
| Professional | | $19.64 | $32.46 | $58.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.44 / $38.96 / $49.28
| Professional | | $37.44 | $38.96 | $49.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.85 / $27.02 / $36.04
| Professional | | $21.85 | $27.02 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $23.24 / $45.70
| Professional | | $12.58 | $23.24 | $45.70 |