- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.72 / $93.64 / $343.00
| Professional | | $65.72 | $93.64 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $38.11 / $51.56 / $188.92
| Professional | 52 | $38.11 | $51.56 | $188.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.33 / $162.33 / $258.14
| Professional | | $162.33 | $162.33 | $258.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.59 / $149.30 / $258.14
| Professional | | $103.59 | $149.30 | $258.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.86 / $145.66 / $190.78
| Professional | | $97.86 | $145.66 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.73 / $139.65 / $291.27
| Professional | | $76.73 | $139.65 | $291.27 |