- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.33 / $104.75 / $136.60
| Professional | | $81.33 | $104.75 | $136.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.52 / $143.80 / $217.34
| Professional | | $103.52 | $143.80 | $217.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.30 / $137.22 / $196.99
| Professional | | $89.30 | $137.22 | $196.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.31 / $126.43 / $189.13
| Facility | | $90.31 | $126.43 | $189.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.89 / $151.72 / $210.61
| Professional | | $112.89 | $151.72 | $210.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.04 / $152.03 / $224.74
| Professional | | $111.04 | $152.03 | $224.74 |