- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.83 / $245.14 / $2,356.25
| Professional | | $158.83 | $245.14 | $2,356.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.83 / $306.37 / $2,697.52
| Professional | | $189.83 | $306.37 | $2,697.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $284.74 / $449.22 / $4,046.29
| Professional | 50 | $284.74 | $449.22 | $4,046.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.67 / $338.65 / $3,363.61
| Professional | | $194.67 | $338.65 | $3,363.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.38 / $450.64 / $3,017.71
| Professional | | $195.38 | $450.64 | $3,017.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.83 / $245.14 / $2,356.25
| Professional | | $158.83 | $245.14 | $2,356.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.78 / $2,787.77 / $3,375.65
| Professional | | $346.78 | $2,787.77 | $3,375.65 |