- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.40 / $128.94 / $2,000.00
| Facility | | $104.40 | $128.94 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.59 / $108.35 / $154.87
| Professional | | $97.59 | $108.35 | $154.87 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $381.00 / $381.00 / $381.41
| Professional | 50 | $381.00 | $381.00 | $381.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.96 / $275.50 / $347.33
| Professional | | $218.96 | $275.50 | $347.33 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $328.44 / $413.25 / $521.00
| Professional | 50 | $328.44 | $413.25 | $521.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.32 / $265.52 / $346.85
| Professional | | $151.32 | $265.52 | $346.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.40 / $174.55 / $229.34
| Facility | | $104.40 | $174.55 | $229.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.86 / $236.54 / $784.00
| Professional | | $137.86 | $236.54 | $784.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.86 / $220.57 / $278.29
| Professional | | $137.86 | $220.57 | $278.29 |