- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.38 / $215.55 / $2,000.00
| Facility | | $82.38 | $215.55 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.04 / $179.40 / $226.57
| Professional | | $77.04 | $179.40 | $226.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.41 / $230.43 / $552.07
| Professional | | $162.41 | $230.43 | $552.07 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $243.62 / $345.65 / $824.58
| Professional | 50 | $243.62 | $345.65 | $824.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.37 / $277.08 / $703.07
| Professional | | $135.37 | $277.08 | $703.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.38 / $215.55 / $381.76
| Facility | | $82.38 | $215.55 | $381.76 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,875.83 / $1,875.83 / $1,875.83
| Facility | 50 | $1,875.83 | $1,875.83 | $1,875.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.34 / $403.13 / $616.79
| Professional | | $218.34 | $403.13 | $616.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.34 / $376.52 / $465.22
| Professional | | $218.34 | $376.52 | $465.22 |