- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $263.03 / $6,456.54
| Facility | | $75.86 | $263.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $75.86 / $147.91
| Professional | | $44.67 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | 50 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $48.98 / $104.71
| Professional | | $38.02 | $48.98 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $162.18 / $218.78
| Facility | | $109.65 | $162.18 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $75.86 / $104.71
| Professional | | $44.67 | $75.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $89.13 / $158.49
| Professional | | $51.29 | $89.13 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $138.04 / $1,659.59
| Facility | | $47.86 | $138.04 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $125.89 / $645.65
| Professional | | $72.44 | $125.89 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $616.60 / $1,659.59
| Facility | | $100.00 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $72.44 / $131.83
| Professional | | $43.65 | $72.44 | $131.83 |