- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.40 / $24.72 / $26.47
| Professional | | $21.40 | $24.72 | $26.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.55 / $27.27 / $30.73
| Professional | | $25.55 | $27.27 | $30.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.21 / $23.21 / $33.34
| Professional | | $23.21 | $23.21 | $33.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.40 / $32.34 / $32.34
| Professional | | $31.40 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.17 / $29.65 / $51.46
| Professional | | $22.17 | $29.65 | $51.46 |