- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $20.34 / $34.22
| Professional | | $16.88 | $20.34 | $34.22 |
- 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
- $16.61 / $22.97 / $34.60
| Professional | | $16.61 | $22.97 | $34.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.57 / $20.27 / $31.68
| Professional | | $15.57 | $20.27 | $31.68 |