- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.10 / $82.56 / $237.31
| Professional | | $37.10 | $82.56 | $237.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.00 / $138.00 / $530.00
| Professional | | $76.00 | $138.00 | $530.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $114.00 / $207.00 / $795.00
| Professional | 50 | $114.00 | $207.00 | $795.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.30 / $127.83 / $328.21
| Professional | | $55.30 | $127.83 | $328.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.04 / $292.32 / $485.04
| Professional | | $172.04 | $292.32 | $485.04 |