- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.68 / $16.04 / $26.30
| Professional | | $11.68 | $16.04 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $23.32 / $114.34
| Professional | | $16.48 | $23.32 | $114.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $25.62 / $31.06
| Professional | | $17.39 | $25.62 | $31.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $32.34 / $32.34
| Professional | | $22.41 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $18.26 / $24.04
| Professional | | $15.52 | $18.26 | $24.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $18.41 / $23.63
| Professional | | $16.57 | $18.41 | $23.63 |