- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $33.32 / $48.28
| Professional | | $22.92 | $33.32 | $48.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.00 / $104.41 / $138.43
| Professional | | $58.00 | $104.41 | $138.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.63 / $109.02 / $169.77
| Professional | | $60.63 | $109.02 | $169.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $102.65 / $153.40
| Professional | | $66.84 | $102.65 | $153.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.23 / $57.29 / $224.54
| Professional | | $29.23 | $57.29 | $224.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.23 / $57.00 / $107.52
| Professional | | $29.23 | $57.00 | $107.52 |