- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $43.65 / $104.71
| Facility | | $30.20 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $52.48 / $102.33
| Professional | | $28.84 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $33.11 / $977.24
| Professional | | $22.39 | $33.11 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $52.48 / $102.33
| Professional | | $28.84 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $66.07 / $97.72
| Professional | | $48.98 | $66.07 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $46.77 / $91.20
| Professional | | $25.12 | $46.77 | $91.20 |