- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $53.70 / $109.65
| Professional | | $39.81 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $66.07 / $109.65
| Professional | | $46.77 | $66.07 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $32.36 / $67.61
| Professional | | $20.42 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $114.82
| Professional | | $74.13 | $100.00 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $83.18 / $109.65
| Professional | | $52.48 | $83.18 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $61.66 / $104.71
| Professional | | $15.85 | $61.66 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $56.23 / $93.33
| Professional | | $45.71 | $56.23 | $93.33 |