- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.11 / $31.58 / $40.36
| Professional | | $27.11 | $31.58 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.41 / $26.46 / $44.31
| Professional | | $19.41 | $26.46 | $44.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $35.21 / $94.67
| Professional | | $16.98 | $35.21 | $94.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.39 / $203.39 / $303.83
| Professional | | $203.39 | $203.39 | $303.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $27.70 / $45.01
| Professional | | $18.43 | $27.70 | $45.01 |