- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.50 / $414.32 / $2,000.00
| Facility | | $26.50 | $414.32 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.98 / $54.28 / $101.95
| Professional | | $23.98 | $54.28 | $101.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.97 / $103.27 / $137.69
| Professional | | $49.97 | $103.27 | $137.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.03 / $89.28 / $186.71
| Professional | | $46.03 | $89.28 | $186.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.50 / $61.14 / $103.94
| Facility | | $26.50 | $61.14 | $103.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.07 / $114.75 / $209.46
| Professional | | $62.07 | $114.75 | $209.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.02 / $92.35 / $131.96
| Professional | | $61.02 | $92.35 | $131.96 |