- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.04 / $231.05 / $292.18
| Facility | | $40.04 | $231.05 | $292.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $34.06 / $68.38
| Professional | | $12.60 | $34.06 | $68.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.27 / $71.31 / $118.88
| Facility | | $37.27 | $71.31 | $118.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $59.76 / $103.46
| Facility | | $20.82 | $59.76 | $103.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $150.00 / $345.40
| Professional | | $100.00 | $150.00 | $345.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |