- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.39 / $22.82 / $43.20
| Professional | | $20.39 | $22.82 | $43.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.25 / $52.62 / $62.17
| Professional | | $48.25 | $52.62 | $62.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.33 / $62.08 / $80.17
| Professional | | $38.33 | $62.08 | $80.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.74 / $41.37 / $153.47
| Professional | | $22.74 | $41.37 | $153.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.22 / $37.52 / $54.05
| Professional | | $21.22 | $37.52 | $54.05 |