- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $634.78 / $1,062.94
| Facility | | $36.00 | $634.78 | $1,062.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $30.30 / $36.01
| Professional | | $30.01 | $30.30 | $36.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.79 / $31.79 / $31.79
| Facility | | $31.79 | $31.79 | $31.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.64 / $31.79 / $31.79
| Professional | | $27.64 | $31.79 | $31.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.81 / $30.01 / $30.01
| Facility | | $15.81 | $30.01 | $30.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $30.01 / $30.01
| Professional | | $30.01 | $30.01 | $30.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $30.01 / $33.25
| Professional | | $30.01 | $30.01 | $33.25 |