- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.73 / $121.91 / $136.41
| Professional | | $97.73 | $121.91 | $136.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.09 / $124.63 / $166.18
| Facility | | $14.09 | $124.63 | $166.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.50 / $113.74 / $151.66
| Professional | | $14.50 | $113.74 | $151.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.41 / $134.41 / $253.88
| Facility | | $134.41 | $134.41 | $253.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $134.41 / $1,027.61
| Professional | | $134.41 | $134.41 | $1,027.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.88 / $103.63 / $153.50
| Professional | | $76.88 | $103.63 | $153.50 |