- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.06 / $72.09 / $121.36
| Professional | | $31.06 | $72.09 | $121.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.00 / $78.00 / $78.00
| Professional | | $78.00 | $78.00 | $78.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.78 / $68.09 / $103.52
| Professional | | $33.78 | $68.09 | $103.52 |
- 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
- $38.61 / $59.76 / $75.22
| Professional | | $38.61 | $59.76 | $75.22 |