- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $204.17 / $758.58
| Facility | | $61.66 | $204.17 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $213.80 / $245.47
| Professional | | $177.83 | $213.80 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $57.54 / $58.88
| Facility | | $50.12 | $57.54 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $1.05 / $107.15
| Professional | | $0.78 | $1.05 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $37.15 / $100.00
| Facility | | $5.37 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $12.88 / $33.88
| Professional | | $8.13 | $12.88 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.14 / $6.03
| Facility | | $2.14 | $2.14 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.13 / $50.12
| Professional | | $14.13 | $14.13 | $50.12 |