- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.08 / $87.42 / $13,298.04
| Facility | | $56.08 | $87.42 | $13,298.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Professional | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $37.47 / $63.36
| Professional | | $24.00 | $37.47 | $63.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.64 / $22.64 / $24.00
| Facility | | $22.64 | $22.64 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.39 / $20.39 / $24.00
| Professional | | $20.39 | $20.39 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.84 / $24.00 / $39.04
| Professional | | $21.84 | $24.00 | $39.04 |