- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.20 / $40.00 / $117.65
| Professional | | $11.20 | $40.00 | $117.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.31 / $13.54 / $89.75
| Professional | | $9.31 | $13.54 | $89.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $10.14 / $13.47
| Professional | | $8.27 | $10.14 | $13.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.15 / $12.28 / $17.39
| Professional | | $10.15 | $12.28 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $12.69 / $17.39
| Professional | | $10.26 | $12.69 | $17.39 |