- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.11 / $138.34 / $2,000.00
| Facility | | $61.11 | $138.34 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.95 / $111.10 / $163.36
| Professional | | $60.95 | $111.10 | $163.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.91 / $235.66 / $398.71
| Professional | | $126.91 | $235.66 | $398.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $190.37 / $270.08 / $598.07
| Professional | 50 | $190.37 | $270.08 | $598.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.78 / $201.91 / $427.31
| Professional | | $104.78 | $201.91 | $427.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.11 / $138.34 / $722.00
| Facility | | $61.11 | $138.34 | $722.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.16 / $253.78 / $362.12
| Professional | | $141.16 | $253.78 | $362.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.38 / $248.49 / $299.41
| Professional | | $140.38 | $248.49 | $299.41 |