- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.87 / $52.03 / $87.58
| Professional | | $25.87 | $52.03 | $87.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.00 / $53.00 / $53.00
| Professional | | $53.00 | $53.00 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.82 / $58.86 / $75.41
| Professional | | $39.82 | $58.86 | $75.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.27 / $45.15 / $55.46
| Professional | | $33.27 | $45.15 | $55.46 |