- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.03 / $71.34 / $85.48
| Professional | | $53.03 | $71.34 | $85.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.20 / $78.31 / $105.01
| Professional | | $28.20 | $78.31 | $105.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $53.92 / $101.10
| Professional | | $17.00 | $53.92 | $101.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.57 / $91.21 / $138.99
| Professional | | $0.57 | $91.21 | $138.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $68.31 / $138.69
| Professional | | $37.36 | $68.31 | $138.69 |