- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.65 / $111.04 / $170.00
| Professional | | $106.65 | $111.04 | $170.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $15.00 / $32.00
| Professional | | $15.00 | $15.00 | $32.00 |
- 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
- $42.24 / $42.24 / $216.18
| Professional | | $42.24 | $42.24 | $216.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.65 / $111.04 / $179.17
| Facility | | $106.65 | $111.04 | $179.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $268.00 / $329.00
| Professional | | $155.00 | $268.00 | $329.00 |