- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.97 / $47.48 / $84.64
| Professional | | $17.97 | $47.48 | $84.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $62.77 / $98.38
| Professional | | $20.23 | $62.77 | $98.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.36 / $57.03 / $104.30
| Professional | | $19.36 | $57.03 | $104.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.95 / $32.04 / $125.09
| Professional | | $0.95 | $32.04 | $125.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.62 / $73.80 / $121.72
| Professional | | $56.62 | $73.80 | $121.72 |