- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $49.30 / $80.04
| Professional | | $32.28 | $49.30 | $80.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.49 / $48.37 / $698.00
| Professional | | $40.49 | $48.37 | $698.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.92 / $48.26 / $186.12
| Professional | | $34.92 | $48.26 | $186.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.72 / $75.13 / $102.39
| Professional | | $49.72 | $75.13 | $102.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.58 / $37.00 / $131.13
| Professional | | $28.58 | $37.00 | $131.13 |