- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $13.03 / $16.03
| Professional | | $10.57 | $13.03 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.11 / $15.84 / $26.70
| Professional | | $12.11 | $15.84 | $26.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.70 / $80.01 / $116.06
| Professional | | $15.70 | $80.01 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.55 / $17.30 / $28.61
| Professional | | $15.55 | $17.30 | $28.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $13.03 / $16.03
| Professional | | $12.15 | $13.03 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $15.48 / $27.65
| Professional | | $12.56 | $15.48 | $27.65 |