- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.09 / $246.28 / $839.27
| Facility | | $71.09 | $246.28 | $839.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $10.84 / $17.04
| Professional | | $9.78 | $10.84 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.00 / $506.01 / $874.00
| Facility | | $221.00 | $506.01 | $874.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $16.43 / $29.75
| Professional | | $14.36 | $16.43 | $29.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.60 / $33.94 / $38.64
| Facility | | $33.60 | $33.94 | $38.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $18.23 / $26.62
| Professional | | $13.34 | $18.23 | $26.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.22 / $15.76 / $24.60
| Professional | | $10.22 | $15.76 | $24.60 |