- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.81 / $66.06 / $83.08
| Facility | | $52.81 | $66.06 | $83.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.17 / $57.71 / $92.58
| Professional | | $27.17 | $57.71 | $92.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.81 / $65.42 / $137.25
| Facility | | $52.81 | $65.42 | $137.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.13 / $55.02 / $79.41
| Professional | | $32.13 | $55.02 | $79.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $133.07 / $133.07
| Professional | | $25.00 | $133.07 | $133.07 |