- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.18 / $12.47 / $17.87
| Professional | | $12.18 | $12.47 | $17.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.52 / $16.22 / $44.28
| Professional | | $15.52 | $16.22 | $44.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $23.06 / $57.55
| Professional | | $14.75 | $23.06 | $57.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.45 / $14.75 / $30.04
| Professional | | $12.45 | $14.75 | $30.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $17.16 / $35.47
| Professional | | $10.48 | $17.16 | $35.47 |