- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.25 / $24.27 / $29.86
| Professional | | $19.25 | $24.27 | $29.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $21.82 / $25.37
| Professional | | $18.00 | $21.82 | $25.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.21 / $23.21 / $23.21
| Professional | | $23.21 | $23.21 | $23.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.72 / $28.69 / $167.64
| Professional | | $22.72 | $28.69 | $167.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $26.64 / $51.12
| Professional | | $22.71 | $26.64 | $51.12 |