- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $18.25 / $46.64
| Professional | | $12.08 | $18.25 | $46.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.81 / $20.62 / $27.27
| Professional | | $15.81 | $20.62 | $27.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $18.68 / $22.64
| Professional | | $13.36 | $18.68 | $22.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $30.00 / $32.34
| Professional | | $10.14 | $30.00 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.22 / $17.91 / $22.13
| Professional | | $15.22 | $17.91 | $22.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.75 / $21.15 / $28.64
| Professional | | $15.75 | $21.15 | $28.64 |