- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $63.10 / $141.25
| Professional | | $42.66 | $63.10 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $69.18 / $977.24
| Professional | | $46.77 | $69.18 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $79.43 / $151.36
| Professional | | $45.71 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $147.91
| Professional | | $74.13 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $75.86 / $147.91
| Professional | | $42.66 | $75.86 | $147.91 |