- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.25 / $36.32 / $140.00
| Professional | | $30.25 | $36.32 | $140.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.07 / $43.70 / $106.98
| Professional | | $37.07 | $43.70 | $106.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.15 / $60.22 / $106.98
| Professional | | $39.15 | $60.22 | $106.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.01 / $59.58 / $71.20
| Professional | | $38.01 | $59.58 | $71.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.67 / $52.77 / $127.92
| Professional | | $32.67 | $52.77 | $127.92 |