- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.66 / $43.21 / $161.31
| Professional | | $30.66 | $43.21 | $161.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.34 / $40.40 / $64.84
| Professional | | $33.34 | $40.40 | $64.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.88 / $43.60 / $44.57
| Professional | | $40.88 | $43.60 | $44.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $39.93 / $64.54
| Professional | | $33.21 | $39.93 | $64.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $32.34 / $51.67
| Professional | | $25.70 | $32.34 | $51.67 |