- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $24.75 / $41.67
| Professional | | $22.71 | $24.75 | $41.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $26.00 / $26.00
| Professional | | $26.00 | $26.00 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.29 / $23.39 / $33.35
| Professional | | $17.29 | $23.39 | $33.35 |
- 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
- $17.05 / $21.87 / $31.56
| Professional | | $17.05 | $21.87 | $31.56 |