- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.24 / $21.24 / $21.24
| Facility | | $21.24 | $21.24 | $21.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $20.68 / $21.41
| Professional | | $15.85 | $20.68 | $21.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.00 / $104.55 / $123.00
| Professional | | $36.00 | $104.55 | $123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.28 / $22.28 / $22.28
| Professional | | $22.28 | $22.28 | $22.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $3,000.00
| Professional | | $45.00 | $45.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.00 / $35.00 / $40.00
| Professional | | $34.00 | $35.00 | $40.00 |