- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $23.42 / $28.10
| Professional | | $11.86 | $23.42 | $28.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.85 / $22.00 / $24.98
| Professional | | $21.85 | $22.00 | $24.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.87 / $19.25 / $76.45
| Professional | | $14.87 | $19.25 | $76.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.22 / $38.51 / $46.83
| Professional | | $31.22 | $38.51 | $46.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $14.05 / $28.02
| Professional | | $11.77 | $14.05 | $28.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $24.82 / $24.82
| Professional | | $15.61 | $24.82 | $24.82 |