- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.66 / $12.91 / $16.91
| Professional | | $10.66 | $12.91 | $16.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $27.36 / $105.73
| Professional | | $11.74 | $27.36 | $105.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $12.08 / $15.41
| Professional | | $10.02 | $12.08 | $15.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.78 / $23.48 / $28.21
| Professional | | $22.78 | $23.48 | $28.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $14.43 / $20.51
| Professional | | $11.84 | $14.43 | $20.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.25 / $13.25 / $13.25
| Professional | | $13.25 | $13.25 | $13.25 |