- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.91 / $524.37 / $2,000.00
| Facility | | $74.91 | $524.37 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.54 / $156.93 / $222.57
| Professional | | $77.54 | $156.93 | $222.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,037.33 / $1,037.33 / $1,037.33
| Professional | 50 | $1,037.33 | $1,037.33 | $1,037.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.63 / $291.75 / $458.72
| Professional | | $146.63 | $291.75 | $458.72 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $219.95 / $284.64 / $688.08
| Professional | 50 | $219.95 | $284.64 | $688.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.52 / $243.00 / $521.16
| Professional | | $100.52 | $243.00 | $521.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.91 / $196.54 / $334.12
| Facility | | $74.91 | $196.54 | $334.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.87 / $346.98 / $513.23
| Professional | | $175.87 | $346.98 | $513.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.74 / $372.86 / $513.23
| Professional | | $201.74 | $372.86 | $513.23 |