- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $15.70 / $18.62
| Professional | | $12.74 | $15.70 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.77 / $15.56 / $15.56
| Professional | | $14.77 | $15.56 | $15.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.67 / $26.01 / $39.68
| Professional | | $20.67 | $26.01 | $39.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $32.13 / $103.02
| Professional | | $20.03 | $32.13 | $103.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.33 / $27.87 / $41.57
| Professional | | $21.33 | $27.87 | $41.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.70 / $31.49 / $41.20
| Professional | | $19.70 | $31.49 | $41.20 |