- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.44 / $19.63 / $35.03
| Professional | | $18.44 | $19.63 | $35.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.13 / $21.13 / $21.13
| Professional | | $21.13 | $21.13 | $21.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $33.75 / $52.51
| Professional | | $32.15 | $33.75 | $52.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $22.57 / $29.45
| Professional | | $19.63 | $22.57 | $29.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $25.44 / $40.39
| Professional | | $17.03 | $25.44 | $40.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.97 / $16.97 / $22.57
| Professional | | $16.97 | $16.97 | $22.57 |