- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $33.11 / $43.65
| Professional | | $22.91 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $38.02 / $128.82
| Professional | | $30.20 | $38.02 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $64,565.42 / $64,565.42
| Professional | | $154.88 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $31.62 / $52.48
| Professional | | $21.38 | $31.62 | $52.48 |