- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $32.36 / $51.29
| Professional | | $25.70 | $32.36 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $91.20 / $102.33
| Professional | | $67.61 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $57.54 / $72.44
| Professional | | $56.23 | $57.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $234.42
| Professional | | $30.20 | $50.12 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $46.77 / $83.18
| Professional | | $32.36 | $46.77 | $83.18 |