- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $11.84 / $539.80
| Professional | | $9.38 | $11.84 | $539.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $16.57 / $16.57
| Professional | | $16.57 | $16.57 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $22.92 / $32.72
| Professional | | $14.41 | $22.92 | $32.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.60 / $27.00 / $34.00
| Professional | | $15.60 | $27.00 | $34.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $16.87 / $29.66
| Professional | | $10.37 | $16.87 | $29.66 |