- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $12.36 / $14.74
| Professional | | $10.28 | $12.36 | $14.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $20.00 / $26.60
| Professional | | $20.00 | $20.00 | $26.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $18.05 / $48.92
| Professional | | $12.87 | $18.05 | $48.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $15.75 / $29.15
| Professional | | $12.40 | $15.75 | $29.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.78 / $17.09 / $36.90
| Professional | | $10.78 | $17.09 | $36.90 |