- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.51 / $49.16 / $57.14
| Professional | | $22.51 | $49.16 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.62 / $27.70 / $34.13
| Professional | | $22.62 | $27.70 | $34.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.61 / $28.61 / $48.36
| Professional | | $28.61 | $28.61 | $48.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.56 / $77.48 / $104.32
| Professional | | $49.56 | $77.48 | $104.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.49 / $29.74 / $42.66
| Professional | | $27.49 | $29.74 | $42.66 |