- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.64 / $120.64 / $139.62
| Professional | | $120.64 | $120.64 | $139.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.71 / $26.71 / $26.71
| Facility | | $26.71 | $26.71 | $26.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.00 / $336.00 / $336.00
| Professional | | $336.00 | $336.00 | $336.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.13 / $265.32 / $336.04
| Facility | | $34.13 | $265.32 | $336.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Professional | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.25 / $45.64 / $68.00
| Professional | | $21.25 | $45.64 | $68.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.51 / $114.77 / $353.21
| Professional | | $76.51 | $114.77 | $353.21 |