- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $100.00 / $346.74
| Facility | | $33.88 | $100.00 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $38.02 / $141.25
| Professional | | $10.23 | $38.02 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $53.70 / $87.10
| Professional | | $33.88 | $53.70 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $213.80 / $316.23
| Facility | | $46.77 | $213.80 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $31.62 / $70.79
| Professional | | $19.95 | $31.62 | $70.79 |