- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.34 / $166.72 / $304.58
| Facility | | $48.34 | $166.72 | $304.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.71 / $56.92 / $150.08
| Professional | | $18.71 | $56.92 | $150.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.00 / $95.00 / $151.00
| Professional | | $52.00 | $95.00 | $151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $49.26 / $79.25
| Professional | | $30.72 | $49.26 | $79.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.59 / $74.83 / $121.00
| Professional | | $40.59 | $74.83 | $121.00 |