- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $81.31 / $8,500.00
| Facility | | $46.68 | $81.31 | $8,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.68 / $80.14 / $266.11
| Professional | | $46.68 | $80.14 | $266.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.68 / $150.44 / $199.75
| Professional | | $94.68 | $150.44 | $199.75 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $142.02 / $183.20 / $294.54
| Professional | 50 | $142.02 | $183.20 | $294.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.09 / $131.84 / $251.06
| Professional | | $69.09 | $131.84 | $251.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.68 / $81.31 / $243.96
| Facility | | $46.68 | $81.31 | $243.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.25 / $155.31 / $212.26
| Professional | | $99.25 | $155.31 | $212.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.98 / $165.42 / $212.26
| Professional | | $90.98 | $165.42 | $212.26 |