- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $48.00 / $476.00
| Facility | | $40.00 | $48.00 | $476.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.81 / $45.00 / $61.00
| Professional | | $33.81 | $45.00 | $61.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.00 / $342.00 / $480.00
| Professional | | $285.00 | $342.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.00 / $372.00 / $372.00
| Professional | | $372.00 | $372.00 | $372.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $60.00
| Professional | | $40.00 | $50.00 | $60.00 |