- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $13.89 / $15.36
| Professional | | $13.05 | $13.89 | $15.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.27 / $25.30 / $37.95
| Professional | | $14.27 | $25.30 | $37.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $17.20 / $20.21
| Professional | | $14.33 | $17.20 | $20.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.74 / $31.92 / $71.44
| Professional | | $20.74 | $31.92 | $71.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $14.59 / $29.98
| Professional | | $10.33 | $14.59 | $29.98 |