- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $14.26 / $26.33
| Professional | | $10.67 | $14.26 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.86 / $18.10 / $25.35
| Professional | | $12.86 | $18.10 | $25.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $21.13 / $33.65
| Professional | | $16.30 | $21.13 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.68 / $24.72 / $35.70
| Professional | | $17.68 | $24.72 | $35.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $23.15 / $35.22
| Professional | | $20.00 | $23.15 | $35.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.03 / $22.07 / $30.51
| Professional | | $14.03 | $22.07 | $30.51 |