- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.31 / $118.94 / $195.46
| Professional | | $71.31 | $118.94 | $195.46 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $27.49 / $138.51 / $466.00
| Professional | 25 | $27.49 | $138.51 | $466.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.15 / $159.30 / $462.76
| Professional | | $135.15 | $159.30 | $462.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $91.47 / $170.16
| Professional | | $50.00 | $91.47 | $170.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.57 / $115.63 / $181.65
| Professional | | $57.57 | $115.63 | $181.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.03 / $147.51 / $300.41
| Professional | | $111.03 | $147.51 | $300.41 |