- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $15.89 / $24.50
| Professional | | $10.37 | $15.89 | $24.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Professional | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $20.73 / $27.56
| Professional | | $10.57 | $20.73 | $27.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.18 / $32.34 / $32.34
| Professional | | $4.18 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.35 / $15.02 / $28.14
| Professional | | $11.35 | $15.02 | $28.14 |