- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.72 / $96.29 / $387.00
| Professional | | $65.72 | $96.29 | $387.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $34.40 / $38.11 / $68.02
| Professional | 52 | $34.40 | $38.11 | $68.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.94 / $165.71 / $253.39
| Professional | | $106.94 | $165.71 | $253.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.85 / $203.26 / $316.52
| Professional | | $125.85 | $203.26 | $316.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.78 / $185.66 / $286.00
| Professional | | $111.78 | $185.66 | $286.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.10 / $146.97 / $265.51
| Professional | | $85.10 | $146.97 | $265.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.40 / $141.47 / $226.96
| Professional | | $79.40 | $141.47 | $226.96 |