- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $44.67 / $87.10
| Professional | | $26.92 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.02 / $48.98
| Professional | | $29.51 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $30.20 / $208.93
| Professional | | $15.85 | $30.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $77.62 / $125.89
| Professional | | $67.61 | $77.62 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $38.90 / $120.23
| Professional | | $25.12 | $38.90 | $120.23 |