- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.58 / $16.70 / $20.74
| Professional | | $14.58 | $16.70 | $20.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.17 / $12.02 / $18.82
| Professional | | $10.17 | $12.02 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $16.91 / $22.80
| Professional | | $13.30 | $16.91 | $22.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $15.35 / $53.71
| Professional | | $11.84 | $15.35 | $53.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.15 / $14.29 / $20.34
| Professional | | $11.15 | $14.29 | $20.34 |