- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.67 / $110.85 / $130.41
| Professional | | $90.67 | $110.85 | $130.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.01 / $175.60 / $259.52
| Professional | | $103.01 | $175.60 | $259.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.35 / $152.55 / $262.67
| Professional | | $117.35 | $152.55 | $262.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.77 / $128.59 / $178.56
| Facility | | $83.77 | $128.59 | $178.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.42 / $155.46 / $273.61
| Professional | | $114.42 | $155.46 | $273.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.16 / $153.94 / $242.37
| Professional | | $126.16 | $153.94 | $242.37 |