- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.24 / $236.48 / $272.54
| Facility | | $207.24 | $236.48 | $272.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.72 / $212.83 / $247.90
| Professional | | $177.72 | $212.83 | $247.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.77 / $71.73 / $201.67
| Facility | | $41.77 | $71.73 | $201.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.00 / $9.00 / $1,960.00
| Professional | | $9.00 | $9.00 | $1,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |