- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $100.00 / $186.21
| Professional | | $47.86 | $100.00 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $97.72 / $186.21
| Professional | | $40.74 | $97.72 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $85.11 / $218.78
| Professional | | $57.54 | $85.11 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $128.82 / $223.87
| Professional | | $51.29 | $128.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $138.04 / $323.59
| Professional | | $52.48 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $128.82 / $223.87
| Professional | | $56.23 | $128.82 | $223.87 |