- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.27 / $309.05 / $788.64
| Professional | | $166.27 | $309.05 | $788.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.00 / $423.00 / $684.00
| Professional | | $290.00 | $423.00 | $684.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $435.00 / $703.50 / $1,026.00
| Professional | 50 | $435.00 | $703.50 | $1,026.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.44 / $346.33 / $592.58
| Professional | | $219.44 | $346.33 | $592.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.61 / $780.63 / $1,290.97
| Professional | | $432.61 | $780.63 | $1,290.97 |