- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $100.00 / $131.83
| Professional | | $72.44 | $100.00 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $66.07 / $186.21
| Professional | | $36.31 | $66.07 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $478.63
| Professional | | $117.49 | $204.17 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.56 / $0.65 / $0.72
| Professional | | $0.56 | $0.65 | $0.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $114.82 / $213.80
| Professional | | $57.54 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $114.82 / $204.17
| Professional | | $72.44 | $114.82 | $204.17 |