- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.94 / $21.94 / $72.00
| Facility | | $21.94 | $21.94 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $21.92 / $22.24
| Professional | | $13.77 | $21.92 | $22.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.80 / $32.86 / $60.25
| Professional | | $24.80 | $32.86 | $60.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,659.72 / $12,659.72 / $15,808.48
| Facility | | $12,659.72 | $12,659.72 | $15,808.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $60.00 / $60.00
| Professional | | $30.00 | $60.00 | $60.00 |