- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $1,122.02
| Professional | | $30.20 | $44.67 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $660.69
| Professional | | $323.59 | $489.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Professional | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $87.10
| Professional | | $50.12 | $54.95 | $87.10 |