- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $41.50 / $262.39
| Professional | | $30.00 | $41.50 | $262.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.55 / $390.68 / $636.61
| Facility | | $106.55 | $390.68 | $636.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.00 / $56.00 / $56.00
| Professional | | $56.00 | $56.00 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $70.00 / $1,500.00
| Professional | | $45.00 | $70.00 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.00 / $56.00 / $56.00
| Professional | | $56.00 | $56.00 | $56.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.00 / $1,158.00 / $1,401.00
| Facility | | $230.00 | $1,158.00 | $1,401.00 |