- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.54 / $62.47 / $86.63
| Professional | | $20.54 | $62.47 | $86.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.66 / $40.36 / $101.52
| Professional | | $21.66 | $40.36 | $101.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.04 / $58.31 / $158.59
| Professional | | $21.04 | $58.31 | $158.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.96 / $64.69 / $204.14
| Professional | | $22.96 | $64.69 | $204.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.08 / $87.80 / $194.78
| Professional | | $52.08 | $87.80 | $194.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.18 / $61.28 / $88.47
| Professional | | $18.18 | $61.28 | $88.47 |