- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $27.96 / $38.71
| Professional | | $25.20 | $27.96 | $38.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.54 / $43.77 / $44.70
| Professional | | $32.54 | $43.77 | $44.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.15 / $35.76 / $44.31
| Professional | | $22.15 | $35.76 | $44.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.04 / $32.15 / $112.47
| Professional | | $22.04 | $32.15 | $112.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.93 / $31.01 / $39.29
| Professional | | $21.93 | $31.01 | $39.29 |