- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.04 / $14.25 / $23.53
| Professional | | $11.04 | $14.25 | $23.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.29 / $13.23 / $31.47
| Professional | | $10.29 | $13.23 | $31.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.94 / $20.58 / $108.10
| Professional | | $11.94 | $20.58 | $108.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.01 / $18.93 / $20.00
| Professional | | $14.01 | $18.93 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.44 / $24.16 / $28.15
| Professional | | $13.44 | $24.16 | $28.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.66 / $17.48 / $26.09
| Professional | | $14.66 | $17.48 | $26.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.58 / $109.58 / $132.83
| Professional | | $109.58 | $109.58 | $132.83 |