- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.47 / $25.84 / $177.03
| Professional | | $17.47 | $25.84 | $177.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.81 / $21.91 / $21.91
| Professional | | $20.81 | $21.91 | $21.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $32.15 / $40.10
| Professional | | $20.27 | $32.15 | $40.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.32 / $22.21 / $152.50
| Professional | | $16.32 | $22.21 | $152.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.26 / $25.57 / $34.83
| Professional | | $18.26 | $25.57 | $34.83 |