- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.43 / $266.51 / $2,574.55
| Professional | | $142.43 | $266.51 | $2,574.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.88 / $323.73 / $2,138.71
| Professional | | $186.88 | $323.73 | $2,138.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $280.32 / $485.59 / $3,208.06
| Professional | 50 | $280.32 | $485.59 | $3,208.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.87 / $323.80 / $2,574.55
| Professional | | $197.87 | $323.80 | $2,574.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.52 / $327.02 / $2,088.82
| Professional | | $165.52 | $327.02 | $2,088.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.43 / $266.51 / $2,574.55
| Professional | | $142.43 | $266.51 | $2,574.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.44 / $2,328.44 / $2,808.67
| Professional | | $1,582.44 | $2,328.44 | $2,808.67 |