- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $234.42 / $851.14
| Professional | | $177.83 | $234.42 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Professional | 50 | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $338.84 / $588.84
| Professional | | $288.40 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $363.08
| Professional | | $199.53 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $588.84
| Professional | | $269.15 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $524.81
| Professional | | $154.88 | $239.88 | $524.81 |