- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $15.57 / $23.09
| Professional | | $12.05 | $15.57 | $23.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $12.88 / $15.45
| Professional | | $9.58 | $12.88 | $15.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $13.67 / $18.45
| Professional | | $10.30 | $13.67 | $18.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $12.36 / $15.21
| Professional | | $10.30 | $12.36 | $15.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.41 / $18.52 / $28.09
| Professional | | $12.41 | $18.52 | $28.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $16.57 / $30.51
| Professional | | $12.54 | $16.57 | $30.51 |