- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.46 / $94.23 / $146.30
| Facility | | $45.46 | $94.23 | $146.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.83 / $13.83 / $29.20
| Professional | | $13.83 | $13.83 | $29.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.00 / $46.00 / $71.00
| Professional | | $34.00 | $46.00 | $71.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.66 / $30.44 / $58.06
| Professional | | $20.66 | $30.44 | $58.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $3,239.00 / $3,239.00
| Facility | | $293.00 | $3,239.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.93 / $59.91 / $106.61
| Professional | | $35.93 | $59.91 | $106.61 |