- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.40 / $46.42 / $109.45
| Professional | | $33.40 | $46.42 | $109.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.72 / $39.72 / $39.72
| Professional | | $39.72 | $39.72 | $39.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.42 / $42.32 / $70.17
| Professional | | $32.42 | $42.32 | $70.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.35 / $81.52
| Professional | | $34.67 | $48.35 | $81.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.26 / $54.64 / $325.73
| Professional | | $34.26 | $54.64 | $325.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.15 / $50.50 / $84.35
| Professional | | $32.15 | $50.50 | $84.35 |