- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.20 / $229.25 / $403.83
| Professional | | $126.20 | $229.25 | $403.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.82 / $476.28 / $938.78
| Professional | | $244.82 | $476.28 | $938.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $367.23 / $693.71 / $1,408.17
| Professional | 50 | $367.23 | $693.71 | $1,408.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.07 / $590.02 / $1,155.31
| Professional | | $321.07 | $590.02 | $1,155.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.00 / $527.99 / $1,003.75
| Professional | | $283.00 | $527.99 | $1,003.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.75 / $731.45 / $1,855.00
| Professional | | $359.75 | $731.45 | $1,855.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.75 / $691.31 / $1,111.51
| Professional | | $359.75 | $691.31 | $1,111.51 |