- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $28.09 / $2,265.94
| Professional | | $27.00 | $28.09 | $2,265.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Professional | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.34 / $38.34 / $38.34
| Professional | | $38.34 | $38.34 | $38.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.70 / $32.40 / $37.79
| Professional | | $29.70 | $32.40 | $37.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $31.52 / $40.50
| Professional | | $27.00 | $31.52 | $40.50 |