- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.51 / $14.46 / $21.94
| Professional | | $13.51 | $14.46 | $21.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.60 / $23.13 / $73.77
| Professional | | $18.60 | $23.13 | $73.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $22.00 / $35.34
| Professional | | $14.05 | $22.00 | $35.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $21.79 / $29.12
| Professional | | $14.54 | $21.79 | $29.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $17.44 / $64.51
| Professional | | $15.77 | $17.44 | $64.51 |