- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.51 / $174.96 / $249.00
| Professional | | $74.51 | $174.96 | $249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.42 / $102.85 / $161.21
| Professional | | $87.42 | $102.85 | $161.21 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $131.13 / $154.27 / $241.81
| Professional | 50 | $131.13 | $154.27 | $241.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.12 / $178.81 / $435.54
| Professional | | $99.12 | $178.81 | $435.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.40 / $277.00 / $444.70
| Professional | | $101.40 | $277.00 | $444.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.51 / $197.62 / $324.89
| Professional | | $74.51 | $197.62 | $324.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.86 / $289.80 / $374.74
| Professional | | $199.86 | $289.80 | $374.74 |