- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $17.63 / $24.87
| Professional | | $13.56 | $17.63 | $24.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.03 / $26.68 / $35.11
| Professional | | $18.03 | $26.68 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.52 / $24.83 / $54.09
| Professional | | $18.52 | $24.83 | $54.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.05 / $22.05 / $26.03
| Professional | | $22.05 | $22.05 | $26.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.52 / $19.05 / $45.77
| Professional | | $13.52 | $19.05 | $45.77 |