- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $43.65 / $107.15
| Professional | | $28.84 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $100.00
| Professional | | $32.36 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $56.23 / $97.72
| Professional | | $42.66 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $81.28 / $147.91
| Professional | | $56.23 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $54.95 / $141.25
| Professional | | $37.15 | $54.95 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $54.95 / $97.72
| Professional | | $35.48 | $54.95 | $97.72 |