- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.27 / $127.17 / $2,000.00
| Facility | | $54.27 | $127.17 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.76 / $118.62 / $163.16
| Professional | | $64.76 | $118.62 | $163.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.02 / $235.32 / $394.57
| Professional | | $142.02 | $235.32 | $394.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $213.03 / $302.27 / $589.34
| Professional | 50 | $213.03 | $302.27 | $589.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.30 / $218.36 / $498.37
| Professional | | $109.30 | $218.36 | $498.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.27 / $127.17 / $330.03
| Facility | | $54.27 | $127.17 | $330.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.72 / $244.80 / $1,087.00
| Professional | | $141.72 | $244.80 | $1,087.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.90 / $243.67 / $296.30
| Professional | | $138.90 | $243.67 | $296.30 |