- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.32 / $64.06 / $88.95
| Professional | | $19.32 | $64.06 | $88.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.77 / $76.11 / $124.45
| Professional | | $21.77 | $76.11 | $124.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $61.31 / $177.20
| Professional | | $20.61 | $61.31 | $177.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.72 / $88.36 / $97.22
| Professional | | $58.72 | $88.36 | $97.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.58 / $78.97 / $157.12
| Professional | | $40.58 | $78.97 | $157.12 |