- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $22.14 / $37.08
| Professional | | $13.54 | $22.14 | $37.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.96 / $19.96 / $19.96
| Professional | | $19.96 | $19.96 | $19.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.15 / $31.13 / $31.70
| Professional | | $26.15 | $31.13 | $31.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.86 / $32.34 / $32.34
| Professional | | $21.86 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.04 / $30.83 / $31.13
| Professional | | $26.04 | $30.83 | $31.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.16 / $17.88 / $30.14
| Professional | | $12.16 | $17.88 | $30.14 |