- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.46 / $74.04 / $92.55
| Professional | | $59.46 | $74.04 | $92.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.18 / $161.06 / $279.63
| Facility | | $68.18 | $161.06 | $279.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.00 / $350.74 / $350.74
| Professional | | $97.00 | $350.74 | $350.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.00 / $101.00 / $101.00
| Facility | | $101.00 | $101.00 | $101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.27 / $97.00 / $154.46
| Professional | | $81.27 | $97.00 | $154.46 |