- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $17.38 / $51.29
| Professional | | $12.02 | $17.38 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.88 / $16.22
| Professional | | $10.00 | $12.88 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $13.80 / $21.38
| Professional | | $10.72 | $13.80 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $12.30 / $16.98
| Professional | | $10.72 | $12.30 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $17.38 / $25.70
| Professional | | $11.75 | $17.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $16.98 / $27.54
| Professional | | $12.59 | $16.98 | $27.54 |