- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $30.85 / $32.64
| Professional | | $14.07 | $30.85 | $32.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $32.47 / $47.86
| Professional | | $18.59 | $32.47 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.16 / $35.45 / $68.59
| Professional | | $19.16 | $35.45 | $68.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.02 / $37.10 / $62.46
| Professional | | $21.02 | $37.10 | $62.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $14.07 / $32.64
| Professional | | $14.07 | $14.07 | $32.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.86 / $61.86 / $86.93
| Professional | | $32.86 | $61.86 | $86.93 |