- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.11 / $76.31 / $110.61
| Professional | | $54.11 | $76.31 | $110.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.81 / $77.81 / $79.37
| Professional | | $77.81 | $77.81 | $79.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.92 / $52.73 / $161.60
| Professional | | $43.92 | $52.73 | $161.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.81 / $105.04 / $128.38
| Professional | | $77.81 | $105.04 | $128.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.29 / $116.71 / $208.58
| Professional | | $70.29 | $116.71 | $208.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $85.59
| Professional | | $32.34 | $32.34 | $85.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.14 / $86.73 / $116.21
| Professional | | $61.14 | $86.73 | $116.21 |