- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $13.43 / $51.20
| Professional | | $10.73 | $13.43 | $51.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $12.07 / $13.58
| Professional | | $10.06 | $12.07 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $18.35 / $19.34
| Professional | | $13.65 | $18.35 | $19.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.67 / $18.28 / $23.90
| Professional | | $11.67 | $18.28 | $23.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.98 / $15.44 / $28.42
| Professional | | $11.98 | $15.44 | $28.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $16.23 / $23.68
| Professional | | $12.95 | $16.23 | $23.68 |