- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.41 / $84.21 / $211.07
| Facility | | $51.41 | $84.21 | $211.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.79 / $51.41 / $51.41
| Professional | | $40.79 | $51.41 | $51.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.83 / $55.10 / $138.38
| Professional | | $28.83 | $55.10 | $138.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.92 / $84.63 / $117.60
| Professional | | $28.92 | $84.63 | $117.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.38 / $70.00 / $70.00
| Professional | | $64.38 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.37 / $61.84 / $159.83
| Professional | | $21.37 | $61.84 | $159.83 |