- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.81 / $33.81 / $360.50
| Facility | | $33.81 | $33.81 | $360.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $38.00 / $300.00
| Professional | | $30.00 | $38.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.00 / $384.00 / $548.00
| Professional | | $244.00 | $384.00 | $548.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $375.00
| Facility | | $375.00 | $375.00 | $375.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.25 / $420.00 / $720.00
| Professional | | $110.25 | $420.00 | $720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.00 / $75.00 / $110.00
| Professional | | $52.00 | $75.00 | $110.00 |