- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.82 / $312.06 / $312.06
| Professional | | $92.82 | $312.06 | $312.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.63 / $105.63 / $105.63
| Professional | | $105.63 | $105.63 | $105.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.39 / $113.58 / $113.58
| Facility | | $100.39 | $113.58 | $113.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.44 / $113.58 / $113.58
| Professional | | $76.44 | $113.58 | $113.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.63 / $108.17 / $113.58
| Facility | | $52.63 | $108.17 | $113.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.22 / $85.24 / $113.65
| Professional | | $80.22 | $85.24 | $113.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.45 / $45.86 / $52.51
| Professional | | $41.45 | $45.86 | $52.51 |