- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.66 / $206.17 / $1,011.44
| Professional | | $204.66 | $206.17 | $1,011.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.59 / $234.38 / $337.32
| Professional | | $202.59 | $234.38 | $337.32 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $258.30 / $303.88 / $337.65
| Professional | 50 | $258.30 | $303.88 | $337.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.71 / $216.00 / $320.82
| Professional | | $111.71 | $216.00 | $320.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.14 / $228.49 / $860.39
| Professional | | $1.14 | $228.49 | $860.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $180.45 / $1,032.47
| Professional | | $0.78 | $180.45 | $1,032.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.68 / $228.32 / $339.57
| Professional | | $182.68 | $228.32 | $339.57 |