- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $17.55 / $38.78
| Professional | | $12.87 | $17.55 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $26.66 / $31.74
| Professional | | $5.48 | $26.66 | $31.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $16.03 / $49.64
| Professional | | $11.75 | $16.03 | $49.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.98 / $19.55 / $27.88
| Professional | | $15.98 | $19.55 | $27.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $8.52 / $10.86
| Professional | | $2.34 | $8.52 | $10.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.81 / $20.35 / $46.17
| Professional | | $15.81 | $20.35 | $46.17 |