- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $38.47 / $103.24
| Professional | | $30.86 | $38.47 | $103.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.51 / $59.41 / $91.33
| Professional | | $40.51 | $59.41 | $91.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $3.66 / $42.46
| Professional | | $2.73 | $3.66 | $42.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.54 / $86.55 / $131.87
| Professional | | $33.54 | $86.55 | $131.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.84 / $32.34 / $53.30
| Professional | | $1.84 | $32.34 | $53.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.04 / $78.48 / $115.65
| Professional | | $48.04 | $78.48 | $115.65 |