- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.69 / $95.22 / $307.00
| Professional | | $35.69 | $95.22 | $307.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $20.19 / $51.21 / $163.84
| Professional | 52 | $20.19 | $51.21 | $163.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.72 / $265.38 / $370.35
| Facility | | $233.72 | $265.38 | $370.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.11 / $109.75 / $224.71
| Professional | | $93.11 | $109.75 | $224.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.32 / $65.77 / $224.71
| Professional | | $31.32 | $65.77 | $224.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.90 / $96.96 / $224.71
| Professional | | $40.90 | $96.96 | $224.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.94 / $119.36 / $275.81
| Professional | | $81.94 | $119.36 | $275.81 |