- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.01 / $37.36 / $737.22
| Facility | | $32.01 | $37.36 | $737.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.36 / $35.97 / $51.01
| Professional | | $27.36 | $35.97 | $51.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $39.00 / $49.52
| Professional | | $24.00 | $39.00 | $49.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $29.37 / $37.72
| Professional | | $23.65 | $29.37 | $37.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.04 / $45.05 / $53.64
| Professional | | $36.04 | $45.05 | $53.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $39.96 / $55.94
| Professional | | $31.78 | $39.96 | $55.94 |