- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.45 / $17.23 / $22.57
| Professional | | $12.45 | $17.23 | $22.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $21.50 / $36.72
| Professional | | $14.75 | $21.50 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.03 / $27.14 / $34.22
| Professional | | $26.03 | $27.14 | $34.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $14.87 / $20.83
| Professional | | $12.64 | $14.87 | $20.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $14.67 / $26.41
| Professional | | $10.71 | $14.67 | $26.41 |