- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.88 / $160.72 / $8,500.00
| Facility | | $127.88 | $160.72 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.47 / $174.52 / $234.22
| Professional | | $136.47 | $174.52 | $234.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $231.28 / $231.28 / $231.28
| Professional | 50 | $231.28 | $231.28 | $231.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.83 / $314.30 / $369.76
| Professional | | $251.83 | $314.30 | $369.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $377.75 / $461.30 / $554.64
| Professional | 50 | $377.75 | $461.30 | $554.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.72 / $270.17 / $419.32
| Professional | | $149.72 | $270.17 | $419.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.88 / $193.28 / $323.80
| Facility | | $127.88 | $193.28 | $323.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.71 / $284.26 / $953.52
| Professional | | $173.71 | $284.26 | $953.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $628.36 / $628.36 / $628.36
| Professional | 50 | $628.36 | $628.36 | $628.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.00 / $271.00 / $271.00
| Facility | | $271.00 | $271.00 | $271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.71 / $261.72 / $346.88
| Professional | | $173.71 | $261.72 | $346.88 |