- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.06 / $107.01 / $207.73
| Facility | | $61.06 | $107.01 | $207.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $64.50 / $110.37
| Professional | | $38.65 | $64.50 | $110.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.24 / $79.65 / $161.86
| Professional | | $38.24 | $79.65 | $161.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.26 / $107.70 / $185.12
| Professional | | $56.26 | $107.70 | $185.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.98 / $120.09 / $162.49
| Professional | | $109.98 | $120.09 | $162.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.34 / $120.47 / $236.76
| Professional | | $73.34 | $120.47 | $236.76 |