- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $14.07 / $25.53
| Professional | | $7.76 | $14.07 | $25.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.98 / $28.78
| Professional | | $9.02 | $16.98 | $28.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $15.77
| Professional | | $15.77 | $15.77 | $15.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.02 / $29.34 / $42.44
| Professional | | $21.02 | $29.34 | $42.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.54 / $47.54 / $47.54
| Professional | | $47.54 | $47.54 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.94 / $27.89 / $54.43
| Professional | | $17.94 | $27.89 | $54.43 |