- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.39 / $302.18 / $2,000.00
| Facility | | $47.39 | $302.18 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.54 / $161.13 / $367.75
| Professional | | $44.54 | $161.13 | $367.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.05 / $130.61 / $614.39
| Professional | | $92.05 | $130.61 | $614.39 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $138.08 / $195.92 / $918.53
| Professional | 50 | $138.08 | $195.92 | $918.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.37 / $80.37 / $80.37
| Facility | | $80.37 | $80.37 | $80.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.69 / $219.01 / $646.19
| Professional | | $57.69 | $219.01 | $646.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.61 / $289.02 / $608.86
| Facility | | $61.61 | $289.02 | $608.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.06 / $653.11 / $2,278.06
| Professional | | $335.06 | $653.11 | $2,278.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.60 / $619.29 / $844.56
| Professional | | $304.60 | $619.29 | $844.56 |