- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.00 / $47.22 / $62.82
| Professional | | $35.00 | $47.22 | $62.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.29 / $76.51 / $107.48
| Professional | | $47.29 | $76.51 | $107.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.84 / $88.41 / $126.30
| Professional | | $31.84 | $88.41 | $126.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.83 / $63.38 / $293.57
| Professional | | $31.83 | $63.38 | $293.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.47 / $79.58 / $107.80
| Professional | | $35.47 | $79.58 | $107.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.42 / $60.21 / $108.96
| Professional | | $32.42 | $60.21 | $108.96 |