- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $21.04 / $41.26
| Professional | | $13.82 | $21.04 | $41.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $18.98 / $33.57
| Professional | | $16.50 | $18.98 | $33.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.87 / $25.60 / $59.21
| Professional | | $17.87 | $25.60 | $59.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.24 / $21.02 / $53.03
| Professional | | $14.24 | $21.02 | $53.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $22.43 / $56.05
| Professional | | $13.66 | $22.43 | $56.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.92 / $17.78 / $42.82
| Professional | | $12.92 | $17.78 | $42.82 |