- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.03 / $220.11 / $248.72
| Professional | | $138.03 | $220.11 | $248.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.00 / $822.00 / $1,329.00
| Professional | | $459.00 | $822.00 | $1,329.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $688.50 / $1,233.00 / $1,993.50
| Professional | 50 | $688.50 | $1,233.00 | $1,993.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.33 / $307.39 / $528.87
| Professional | | $210.33 | $307.39 | $528.87 |
- 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
- $312.64 / $523.05 / $884.01
| Professional | | $312.64 | $523.05 | $884.01 |