- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $28.58 / $36.72
| Professional | | $22.07 | $28.58 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.73 / $20.79 / $36.83
| Professional | | $14.73 | $20.79 | $36.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.02 / $26.63 / $43.06
| Professional | | $19.02 | $26.63 | $43.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $41.61 / $80.00
| Professional | | $32.34 | $41.61 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.02 / $26.63 / $43.06
| Professional | | $19.02 | $26.63 | $43.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $30.40 / $45.60
| Professional | | $18.00 | $30.40 | $45.60 |