- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $16.07 / $19.27
| Professional | | $13.36 | $16.07 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.85 / $72.00 / $103.27
| Professional | | $13.85 | $72.00 | $103.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $13.00 / $15.52
| Professional | | $9.16 | $13.00 | $15.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.08 / $32.34 / $32.34
| Professional | | $12.08 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $12.44 / $17.68
| Professional | | $10.57 | $12.44 | $17.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.47 / $14.00 / $22.67
| Professional | | $9.47 | $14.00 | $22.67 |