- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $19.38 / $57.19
| Professional | | $14.40 | $19.38 | $57.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.48 / $30.29 / $111.05
| Professional | | $25.48 | $30.29 | $111.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.35 / $84.63 / $116.06
| Professional | | $27.35 | $84.63 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.73 / $84.63 / $116.06
| Professional | | $27.73 | $84.63 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $30.66 / $69.98
| Professional | | $28.02 | $30.66 | $69.98 |