- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.10 / $29.70 / $52.22
| Professional | | $17.10 | $29.70 | $52.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.03 / $40.54 / $74.25
| Professional | | $21.03 | $40.54 | $74.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.33 / $41.24 / $73.52
| Professional | | $22.33 | $41.24 | $73.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.22 / $315.76 / $347.13
| Professional | | $163.22 | $315.76 | $347.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $49.05 / $84.82
| Professional | | $28.59 | $49.05 | $84.82 |