- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $36.31 / $46.77
| Professional | | $28.18 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $25.70 / $47.86
| Professional | | $19.95 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $36.31 / $56.23
| Professional | | $17.38 | $36.31 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $28.84 / $39.81
| Professional | | $17.38 | $28.84 | $39.81 |