- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.56 / $30.42 / $30.84
| Professional | | $22.56 | $30.42 | $30.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.47 / $33.54 / $46.37
| Professional | | $17.47 | $33.54 | $46.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.33 / $35.29 / $91.70
| Professional | | $25.33 | $35.29 | $91.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.57 / $25.18 / $34.81
| Professional | | $9.57 | $25.18 | $34.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $42.50 / $106.28
| Professional | | $18.00 | $42.50 | $106.28 |