- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.81 / $84.57 / $2,000.00
| Facility | | $52.81 | $84.57 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $73.14 / $150.00
| Professional | | $47.53 | $73.14 | $150.00 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $195.99 / $195.99 / $195.99
| Professional | 50 | $195.99 | $195.99 | $195.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.58 / $132.31 / $227.62
| Professional | | $102.58 | $132.31 | $227.62 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $153.87 / $198.47 / $335.52
| Professional | 50 | $153.87 | $198.47 | $335.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.83 / $156.12 / $236.90
| Professional | | $83.83 | $156.12 | $236.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.81 / $86.15 / $154.19
| Facility | | $52.81 | $86.15 | $154.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.87 / $155.13 / $386.24
| Professional | | $87.87 | $155.13 | $386.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.62 / $153.32 / $182.53
| Professional | | $86.62 | $153.32 | $182.53 |