- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $40.74 / $120.23
| Professional | | $30.20 | $40.74 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $562.34 / $3,235.94
| Professional | | $9.77 | $562.34 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $30.90 / $74.13
| Professional | | $22.91 | $30.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $67.61 / $67.61
| Professional | | $52.48 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $33.11 / $74.13
| Professional | | $21.88 | $33.11 | $74.13 |