- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.01 / $21.35 / $35.40
| Professional | | $18.01 | $21.35 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.66 / $33.02 / $63.45
| Professional | | $10.66 | $33.02 | $63.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.71 / $23.57 / $30.88
| Professional | | $16.71 | $23.57 | $30.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.79 / $26.79 / $33.39
| Professional | | $26.79 | $26.79 | $33.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.01 / $21.35 / $35.40
| Professional | | $18.01 | $21.35 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.92 / $27.79 / $67.02
| Professional | | $15.92 | $27.79 | $67.02 |