- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.37 / $104.57 / $140.05
| Professional | | $81.37 | $104.57 | $140.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.31 / $147.31 / $147.31
| Professional | | $147.31 | $147.31 | $147.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $110.00 / $112.20
| Facility | | $110.00 | $110.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.50 / $93.50 / $93.50
| Professional | | $93.50 | $93.50 | $93.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $110.00 / $112.20
| Facility | | $110.00 | $110.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.48 / $149.28 / $216.87
| Professional | | $49.48 | $149.28 | $216.87 |