- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.03 / $39.36 / $164.71
| Professional | | $23.03 | $39.36 | $164.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.93 / $56.50 / $124.07
| Professional | | $47.93 | $56.50 | $124.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.38 / $54.93 / $124.07
| Professional | | $38.38 | $54.93 | $124.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.15 / $50.85 / $110.74
| Professional | | $40.15 | $50.85 | $110.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.25 / $52.35 / $78.18
| Professional | | $32.25 | $52.35 | $78.18 |