- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.52 / $390.52 / $570.00
| Facility | | $390.52 | $390.52 | $570.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $106.65 / $760.95 / $941.63
| Facility | 25 | $106.65 | $760.95 | $941.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.77 / $41.31 / $152.10
| Professional | | $31.77 | $41.31 | $152.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.00 / $74.00 / $74.00
| Professional | | $74.00 | $74.00 | $74.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.61 / $60.93 / $87.10
| Professional | | $39.61 | $60.93 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.73 / $77.34 / $123.21
| Professional | | $62.73 | $77.34 | $123.21 |