- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.30 / $136.26 / $168.18
| Professional | | $87.30 | $136.26 | $168.18 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $41.32 / $68.13 / $111.02
| Professional | 52 | $41.32 | $68.13 | $111.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.90 / $174.72 / $498.55
| Professional | | $143.90 | $174.72 | $498.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.03 / $144.85 / $386.61
| Professional | | $92.03 | $144.85 | $386.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.41 / $186.04 / $386.61
| Professional | | $118.41 | $186.04 | $386.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.01 / $187.12 / $543.98
| Professional | | $135.01 | $187.12 | $543.98 |