- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.00 / $45.00 / $474.00
| Professional | | $35.00 | $45.00 | $474.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $238.00 / $336.00
| Professional | | $200.00 | $238.00 | $336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.00 / $104.00 / $3,395.00
| Facility | | $35.00 | $104.00 | $3,395.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $55.00 / $1,351.68
| Professional | | $38.00 | $55.00 | $1,351.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.00 / $46.00 / $80.56
| Professional | | $36.00 | $46.00 | $80.56 |