- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.73 / $114.69 / $134.93
| Facility | | $75.73 | $114.69 | $134.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.72 / $103.70 / $138.78
| Professional | | $52.72 | $103.70 | $138.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.92 / $107.02 / $166.23
| Professional | | $88.92 | $107.02 | $166.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.61 / $94.06 / $113.84
| Professional | | $71.61 | $94.06 | $113.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.61 / $100.44 / $129.31
| Facility | | $90.61 | $100.44 | $129.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.73 / $92.84 / $132.30
| Professional | | $71.73 | $92.84 | $132.30 |