- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.40 / $26.10 / $29.86
| Professional | | $21.40 | $26.10 | $29.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.51 / $26.98 / $35.46
| Professional | | $17.51 | $26.98 | $35.46 |
- 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
- $23.66 / $35.67 / $167.64
| Professional | | $23.66 | $35.67 | $167.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $33.09 / $59.55
| Professional | | $22.70 | $33.09 | $59.55 |