- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.64 / $251.09 / $2,000.00
| Facility | | $118.64 | $251.09 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $193.09 / $251.24
| Professional | | $116.27 | $193.09 | $251.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.02 / $323.12 / $618.38
| Professional | | $238.02 | $323.12 | $618.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $357.03 / $506.58 / $927.57
| Professional | 50 | $357.03 | $506.58 | $927.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.73 / $388.34 / $796.31
| Professional | | $190.73 | $388.34 | $796.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.64 / $251.09 / $432.86
| Facility | | $118.64 | $251.09 | $432.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.44 / $265.92 / $1,831.00
| Professional | | $199.44 | $265.92 | $1,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.98 / $265.92 / $541.92
| Professional | | $209.98 | $265.92 | $541.92 |