- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $40.07 / $129.01
| Professional | | $12.50 | $40.07 | $129.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.26 / $21.93 / $30.14
| Professional | | $13.26 | $21.93 | $30.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.37 / $29.86 / $37.32
| Professional | | $21.37 | $29.86 | $37.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $29.67
| Professional | | $12.07 | $12.07 | $29.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $24.16 / $30.88
| Professional | | $13.30 | $24.16 | $30.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $12.85 / $29.67
| Professional | | $12.07 | $12.85 | $29.67 |