- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.80 / $36.29 / $36.57
| Professional | | $19.80 | $36.29 | $36.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $31.43 / $46.62
| Professional | | $18.20 | $31.43 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.71 / $45.32 / $73.64
| Professional | | $21.71 | $45.32 | $73.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.68 / $50.05 / $325.02
| Professional | | $30.68 | $50.05 | $325.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $38.61 / $61.74
| Professional | | $28.87 | $38.61 | $61.74 |