- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.12 / $95.40 / $130.02
| Facility | | $68.12 | $95.40 | $130.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.52 / $85.44 / $122.30
| Professional | | $51.52 | $85.44 | $122.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.74 / $120.87 / $120.87
| Professional | | $102.74 | $120.87 | $120.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.57 / $94.19 / $127.56
| Professional | | $49.57 | $94.19 | $127.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.66 / $83.56 / $117.47
| Professional | | $54.66 | $83.56 | $117.47 |