- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.60 / $58.67 / $145.16
| Professional | | $45.60 | $58.67 | $145.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $104.00 / $104.00
| Professional | | $104.00 | $104.00 | $104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.36 / $74.03 / $125.00
| Professional | | $46.36 | $74.03 | $125.00 |
- 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
- $57.82 / $72.06 / $137.72
| Professional | | $57.82 | $72.06 | $137.72 |