- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.71 / $21.60 / $26.41
| Professional | | $19.71 | $21.60 | $26.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.68 / $25.33 / $36.72
| Professional | | $19.68 | $25.33 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $28.97 / $58.46
| Professional | | $20.05 | $28.97 | $58.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.36 / $31.55 / $276.20
| Professional | | $20.36 | $31.55 | $276.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.11 / $28.05 / $48.29
| Professional | | $20.11 | $28.05 | $48.29 |