- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.65 / $478.31 / $737.50
| Facility | | $93.65 | $478.31 | $737.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.75 / $77.93 / $105.42
| Professional | | $24.75 | $77.93 | $105.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.87 / $63.01 / $106.48
| Professional | | $27.87 | $63.01 | $106.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.65 / $567.12 / $880.10
| Facility | | $77.65 | $567.12 | $880.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.98 / $26.98 / $26.98
| Professional | | $26.98 | $26.98 | $26.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.44 / $81.26 / $175.96
| Professional | | $50.44 | $81.26 | $175.96 |