- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $15.57 / $38.27
| Professional | | $12.28 | $15.57 | $38.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $27.07 / $30.40
| Professional | | $22.52 | $27.07 | $30.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.64 / $26.18 / $39.34
| Professional | | $17.64 | $26.18 | $39.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $30.03 / $90.53
| Professional | | $16.23 | $30.03 | $90.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.57 / $28.74 / $34.64
| Professional | | $15.57 | $28.74 | $34.64 |