- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $10.14 / $31.66
| Professional | | $5.42 | $10.14 | $31.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $11.67 / $29.00
| Professional | | $10.61 | $11.67 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.15 / $10.69 / $25.35
| Professional | | $6.15 | $10.69 | $25.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $12.55 / $23.87
| Professional | | $10.16 | $12.55 | $23.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $7.39 / $14.22
| Professional | | $4.30 | $7.39 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.95 / $13.76 / $15.29
| Professional | | $11.95 | $13.76 | $15.29 |