- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.59 / $519.38 / $1,377.10
| Facility | | $44.59 | $519.38 | $1,377.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.59 / $44.59 / $2,126.41
| Professional | | $44.59 | $44.59 | $2,126.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.00 / $108.46 / $136.97
| Professional | | $108.00 | $108.46 | $136.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.67 / $343.67 / $343.67
| Professional | | $343.67 | $343.67 | $343.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $3,000.00
| Professional | | $45.00 | $45.00 | $3,000.00 |