- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.66 / $105.63 / $122.60
| Professional | | $90.66 | $105.63 | $122.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.05 / $110.62 / $147.49
| Facility | | $14.05 | $110.62 | $147.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.29 / $114.15 / $158.84
| Professional | | $12.29 | $114.15 | $158.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.51 / $115.51 / $228.48
| Facility | | $115.51 | $115.51 | $228.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.51 / $138.02 / $151.61
| Professional | | $115.51 | $138.02 | $151.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.21 / $153.21 / $153.21
| Professional | | $153.21 | $153.21 | $153.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.47 / $105.37 / $188.41
| Professional | | $89.47 | $105.37 | $188.41 |