- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.30 / $47.07 / $121.26
| Professional | | $24.30 | $47.07 | $121.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.80 / $40.07 / $51.32
| Professional | | $22.80 | $40.07 | $51.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $32.64 / $66.39
| Professional | | $23.71 | $32.64 | $66.39 |