- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.15 / $25.36 / $36.24
| Facility | | $24.15 | $25.36 | $36.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.15 / $24.15 / $70.25
| Professional | | $24.15 | $24.15 | $70.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.25 / $50.00 / $80.00
| Professional | | $38.25 | $50.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.85 / $1,737.50 / $2,814.11
| Facility | | $1,193.85 | $1,737.50 | $2,814.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.24 / $36.34 / $85.64
| Professional | | $29.24 | $36.34 | $85.64 |