- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.03 / $100.81 / $2,000.00
| Facility | | $60.03 | $100.81 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.72 / $93.67 / $146.34
| Professional | | $57.72 | $93.67 | $146.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.72 / $162.63 / $243.71
| Professional | | $115.72 | $162.63 | $243.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $173.58 / $224.64 / $365.57
| Professional | 50 | $173.58 | $224.64 | $365.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.23 / $164.82 / $260.14
| Professional | | $89.23 | $164.82 | $260.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.03 / $100.81 / $193.43
| Facility | | $60.03 | $100.81 | $193.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.15 / $200.27 / $1,297.00
| Professional | | $113.15 | $200.27 | $1,297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.86 / $184.94 / $226.29
| Professional | | $102.86 | $184.94 | $226.29 |