- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.64 / $34.65 / $10,911.19
| Facility | | $34.64 | $34.65 | $10,911.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $34.65 / $147.40
| Professional | | $34.65 | $34.65 | $147.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $14.12 / $14.12
| Professional | | $12.61 | $14.12 | $14.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $125.40 / $125.40
| Professional | | $125.40 | $125.40 | $125.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $3,000.00 / $4,024.75
| Professional | | $2,500.00 | $3,000.00 | $4,024.75 |