- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.44 / $20.30 / $23.93
| Professional | | $17.44 | $20.30 | $23.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $21.25 / $23.47
| Professional | | $13.55 | $21.25 | $23.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $22.06 / $63.28
| Professional | | $16.88 | $22.06 | $63.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.53 / $23.53 / $23.53
| Professional | | $23.53 | $23.53 | $23.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $23.97 / $61.74
| Professional | | $13.49 | $23.97 | $61.74 |