- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $107.15 / $323.59
| Professional | | $64.57 | $107.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $74.13 / $177.83 / $575.44
| Professional | 50 | $74.13 | $177.83 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,071.52 / $1,122.02
| Facility | | $1,000.00 | $1,071.52 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $158.49 / $263.03
| Professional | | $134.90 | $158.49 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $97.72 / $158.49
| Professional | | $61.66 | $97.72 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $107.15 / $141.25
| Professional | | $74.13 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $100.00 / $208.93
| Professional | | $70.79 | $100.00 | $208.93 |