- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $22.82 / $27.40
| Professional | | $21.20 | $22.82 | $27.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $41.50 / $48.82
| Professional | | $21.48 | $41.50 | $48.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.92 / $27.38 / $47.27
| Professional | | $21.92 | $27.38 | $47.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.80 / $21.80 / $21.80
| Professional | | $21.80 | $21.80 | $21.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.70 / $21.59 / $33.03
| Professional | | $15.70 | $21.59 | $33.03 |