- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.36 / $22.01 / $27.95
| Facility | | $19.36 | $22.01 | $27.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.89 / $21.65 / $25.83
| Professional | | $14.89 | $21.65 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.25 / $45.00 / $80.00
| Professional | | $38.25 | $45.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.00 / $1,632.00 / $5,253.00
| Facility | | $743.00 | $1,632.00 | $5,253.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.78 / $27.48 / $40.69
| Professional | | $20.78 | $27.48 | $40.69 |