- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.96 / $29.28 / $40.04
| Professional | | $23.96 | $29.28 | $40.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.74 / $32.40 / $51.71
| Professional | | $23.74 | $32.40 | $51.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.74 / $57.74 / $57.74
| Professional | | $57.74 | $57.74 | $57.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $100.00 / $100.00
| Professional | | $70.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.28 / $43.58 / $76.03
| Professional | | $35.28 | $43.58 | $76.03 |