- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.48 / $124.10 / $246.61
| Professional | | $20.48 | $124.10 | $246.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.07 / $32.07 / $251.86
| Professional | | $32.07 | $32.07 | $251.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.07 / $251.86 / $299.38
| Facility | | $32.07 | $251.86 | $299.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.79 / $106.18 / $345.27
| Professional | | $25.79 | $106.18 | $345.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.30 / $172.04 / $417.06
| Facility | | $22.30 | $172.04 | $417.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.07 / $190.54 / $474.97
| Professional | | $32.07 | $190.54 | $474.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.70 / $318.08 / $380.56
| Professional | | $265.70 | $318.08 | $380.56 |