- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.76 / $22.57
| Professional | | $21.31 | $21.76 | $22.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.47 / $34.97 / $61.88
| Professional | | $17.47 | $34.97 | $61.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.43 / $35.18 / $43.71
| Professional | | $20.43 | $35.18 | $43.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.14 / $35.54 / $170.38
| Professional | | $27.14 | $35.54 | $170.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.01 / $33.25 / $67.52
| Professional | | $27.01 | $33.25 | $67.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $21.70 / $3,000.00
| Professional | | $17.35 | $21.70 | $3,000.00 |