- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.78 / $13.50 / $15.91
| Professional | | $10.78 | $13.50 | $15.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.76 / $14.61 / $24.40
| Professional | | $8.76 | $14.61 | $24.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.60 / $16.79 / $19.71
| Professional | | $14.60 | $16.79 | $19.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.26 / $24.56 / $111.17
| Professional | | $14.26 | $24.56 | $111.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.84 / $16.57 / $22.46
| Professional | | $13.84 | $16.57 | $22.46 |