- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.53 / $23.01 / $24.93
| Professional | | $15.53 | $23.01 | $24.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $25.33 / $33.02
| Professional | | $22.71 | $25.33 | $33.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.64 / $34.02 / $45.25
| Professional | | $24.64 | $34.02 | $45.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.65 / $26.79 / $41.69
| Professional | | $15.65 | $26.79 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.53 / $23.01 / $23.01
| Professional | | $15.53 | $23.01 | $23.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.62 / $25.08 / $38.01
| Professional | | $17.62 | $25.08 | $38.01 |