- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $70.79 / $138.04
| Professional | | $43.65 | $70.79 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $93.33 / $151.36
| Professional | | $58.88 | $93.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $72.44 / $154.88
| Professional | | $45.71 | $72.44 | $154.88 |