- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.05 / $16.67 / $23.64
| Professional | | $12.05 | $16.67 | $23.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.22 / $13.22 / $13.88
| Professional | | $13.22 | $13.22 | $13.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.67 / $21.56 / $47.71
| Professional | | $14.67 | $21.56 | $47.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $18.11 / $37.86
| Professional | | $13.82 | $18.11 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.08 / $18.62 / $31.65
| Professional | | $13.08 | $18.62 | $31.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.71 / $19.05 / $36.94
| Professional | | $12.71 | $19.05 | $36.94 |