- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.78 / $106.42 / $518.22
| Professional | | $20.78 | $106.42 | $518.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.71 / $33.82 / $38.38
| Professional | | $30.71 | $33.82 | $38.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $19.28 / $147.94
| Professional | | $12.89 | $19.28 | $147.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.83 / $33.86 / $43.24
| Professional | | $22.83 | $33.86 | $43.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $38.43 / $44.63
| Professional | | $28.59 | $38.43 | $44.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.50 / $28.31 / $41.40
| Professional | | $17.50 | $28.31 | $41.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.70 / $27.70 / $27.70
| Professional | | $27.70 | $27.70 | $27.70 |