- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $25.18 / $113.52
| Professional | | $19.14 | $25.18 | $113.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $18.62 / $22.60
| Professional | | $14.07 | $18.62 | $22.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.25 / $59.23 / $223.20
| Professional | | $17.25 | $59.23 | $223.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.89 / $106.40 / $204.77
| Professional | | $91.89 | $106.40 | $204.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.41 / $69.62 / $205.57
| Professional | | $46.41 | $69.62 | $205.57 |