- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.70 / $26.46 / $31.18
| Professional | | $20.70 | $26.46 | $31.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $17.77 / $29.42
| Professional | | $16.82 | $17.77 | $29.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.11 / $28.43 / $53.18
| Professional | | $16.11 | $28.43 | $53.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.34 / $35.53 / $42.82
| Professional | | $30.34 | $35.53 | $42.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.11 / $21.12 / $28.58
| Professional | | $13.11 | $21.12 | $28.58 |