- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $44.07 / $51.33
| Professional | | $22.07 | $44.07 | $51.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.21 / $25.70 / $27.77
| Professional | | $22.21 | $25.70 | $27.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $25.65 / $43.09
| Professional | | $25.65 | $25.65 | $43.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.43 / $70.00 / $100.00
| Professional | | $44.43 | $70.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.65 / $26.66 / $38.25
| Professional | | $24.65 | $26.66 | $38.25 |