- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $588.84 / $588.84
| Facility | | $524.81 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $12.88 / $45.71
| Professional | | $7.94 | $12.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.00 / $1.00 / $1.51
| Professional | | $1.00 | $1.00 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $27.54
| Professional | | $12.59 | $12.59 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $93.33 / $100.00
| Professional | | $64.57 | $93.33 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $60.26
| Professional | | $34.67 | $39.81 | $60.26 |