- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $46.37 / $61.42
| Professional | | $31.67 | $46.37 | $61.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $31.10 / $51.79
| Professional | | $5.78 | $31.10 | $51.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $46.28 / $81.20
| Professional | | $9.84 | $46.28 | $81.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $42.80 / $293.57
| Professional | | $12.56 | $42.80 | $293.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.00 / $42.41 / $86.54
| Professional | | $22.00 | $42.41 | $86.54 |