- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.52 / $35.40 / $52.78
| Professional | | $23.52 | $35.40 | $52.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.24 / $36.04 / $55.13
| Professional | | $34.24 | $36.04 | $55.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.44 / $71.04 / $236.32
| Professional | | $36.44 | $71.04 | $236.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.20 / $47.30 / $124.48
| Professional | | $36.20 | $47.30 | $124.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.35 / $57.70 / $131.41
| Professional | | $37.35 | $57.70 | $131.41 |