- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $46.77 / $81.28
| Professional | | $30.20 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $102.33
| Professional | | $39.81 | $61.66 | $102.33 |
- 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
- $31.62 / $47.86 / $102.33
| Professional | | $31.62 | $47.86 | $102.33 |