- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $24.52 / $64.03
| Professional | | $22.63 | $24.52 | $64.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.16 / $27.54 / $38.04
| Professional | | $20.16 | $27.54 | $38.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $28.98 / $36.68
| Professional | | $22.92 | $28.98 | $36.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.01 / $28.71 / $31.88
| Professional | | $27.01 | $28.71 | $31.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.19 / $22.74 / $36.54
| Professional | | $18.19 | $22.74 | $36.54 |