- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.56 / $80.15 / $1,433.93
| Professional | | $53.56 | $80.15 | $1,433.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.00 / $247.00 / $5,184.00
| Professional | | $128.00 | $247.00 | $5,184.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $192.00 / $370.50 / $7,776.00
| Professional | 50 | $192.00 | $370.50 | $7,776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.85 / $139.81 / $2,645.03
| Professional | | $83.85 | $139.81 | $2,645.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,749.37 / $2,772.19 / $4,800.91
| Professional | | $1,749.37 | $2,772.19 | $4,800.91 |