- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.17 / $497.10 / $950.00
| Facility | | $78.17 | $497.10 | $950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.31 / $210.86 / $475.00
| Professional | | $140.31 | $210.86 | $475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.27 / $498.05 / $750.00
| Facility | | $50.27 | $498.05 | $750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.86 / $105.17 / $259.98
| Professional | | $78.86 | $105.17 | $259.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $40.00
| Professional | | $17.00 | $20.00 | $40.00 |