- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $15.45 / $20.37
| Professional | | $9.67 | $15.45 | $20.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.06 / $25.92 / $31.23
| Professional | | $12.06 | $25.92 | $31.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $11.24 / $11.24
| Professional | | $11.24 | $11.24 | $11.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.04 / $33.04 / $33.04
| Professional | | $33.04 | $33.04 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.69 / $15.58 / $20.87
| Professional | | $11.69 | $15.58 | $20.87 |