- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.28 / $615.60 / $1,282.53
| Facility | | $25.28 | $615.60 | $1,282.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $25.28 / $37.95
| Professional | | $20.98 | $25.28 | $37.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.35 / $653.64 / $1,120.94
| Facility | | $181.35 | $653.64 | $1,120.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.94 / $22.94 / $22.94
| Facility | | $22.94 | $22.94 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $29.74 / $37.17
| Professional | | $11.06 | $29.74 | $37.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Professional | | $60.00 | $60.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.54 / $22.15 / $37.95
| Facility | | $18.54 | $22.15 | $37.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $24.36 / $45.47
| Professional | | $11.06 | $24.36 | $45.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $10.84 / $21.87
| Professional | | $9.84 | $10.84 | $21.87 |