- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.99 / $310.11 / $2,902.00
| Professional | | $158.99 | $310.11 | $2,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.44 / $382.40 / $2,636.75
| Professional | | $218.44 | $382.40 | $2,636.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $327.66 / $573.60 / $3,955.12
| Professional | 50 | $327.66 | $573.60 | $3,955.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.25 / $376.78 / $3,081.13
| Professional | | $230.25 | $376.78 | $3,081.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.52 / $386.29 / $2,575.23
| Professional | | $195.52 | $386.29 | $2,575.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.99 / $310.11 / $2,917.98
| Professional | | $158.99 | $310.11 | $2,917.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.01 / $2,867.27 / $3,460.50
| Professional | | $2,099.01 | $2,867.27 | $3,460.50 |