- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.92 / $40.45 / $164.00
| Professional | | $34.92 | $40.45 | $164.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.37 / $55.73 / $55.73
| Professional | | $47.37 | $55.73 | $55.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.47 / $48.92 / $71.98
| Professional | | $34.47 | $48.92 | $71.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.35 / $55.73 / $88.05
| Professional | | $34.35 | $55.73 | $88.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.39 / $52.51 / $63.06
| Professional | | $45.39 | $52.51 | $63.06 |