- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $17.04 / $50.40
| Professional | | $13.65 | $17.04 | $50.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $20.45 / $44.03
| Professional | | $17.35 | $20.45 | $44.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.48 / $25.73 / $44.03
| Professional | | $17.48 | $25.73 | $44.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.25 / $24.77 / $35.34
| Professional | | $17.25 | $24.77 | $35.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.13 / $22.88 / $54.05
| Professional | | $16.13 | $22.88 | $54.05 |