- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.20 / $17.59 / $52.31
| Professional | | $13.20 | $17.59 | $52.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.08 / $24.48 / $44.39
| Professional | | $14.08 | $24.48 | $44.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.66 / $20.12 / $25.30
| Professional | | $19.66 | $20.12 | $25.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.05 / $12.80 / $15.06
| Professional | | $4.05 | $12.80 | $15.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $16.32 / $35.79
| Professional | | $11.01 | $16.32 | $35.79 |