- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $56.23 / $69.18
| Professional | | $12.02 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $26.30 / $27.54
| Professional | | $24.55 | $26.30 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $38.90 / $48.98
| Professional | | $33.88 | $38.90 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $20.89 / $331.13
| Professional | | $13.49 | $20.89 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $20.89 / $29.51
| Professional | | $12.30 | $20.89 | $29.51 |