- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.00 / $220.00 / $300.00
| Facility | | $45.00 | $220.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $45.00 / $302.44
| Professional | | $32.50 | $45.00 | $302.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.00 / $208.00 / $324.00
| Professional | | $148.00 | $208.00 | $324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.50 / $210.00 / $284.70
| Professional | | $142.50 | $210.00 | $284.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $55.00
| Facility | | $55.00 | $55.00 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $60.00 / $84.00
| Professional | | $45.00 | $60.00 | $84.00 |