- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.80 / $181.17 / $243.09
| Facility | | $82.80 | $181.17 | $243.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.59 / $275.63 / $598.50
| Professional | | $151.59 | $275.63 | $598.50 |
- 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 |