- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.81 / $10.59 / $14.54
| Professional | | $6.81 | $10.59 | $14.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.83 / $9.48 / $14.47
| Professional | | $5.83 | $9.48 | $14.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.10 / $11.34 / $21.57
| Professional | | $8.10 | $11.34 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.34 / $14.12 / $28.67
| Professional | | $8.34 | $14.12 | $28.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.50 / $32.34 / $32.34
| Professional | | $16.50 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $15.69 / $24.87
| Professional | | $12.28 | $15.69 | $24.87 |