- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.07 / $150.43 / $174.76
| Professional | | $135.07 | $150.43 | $174.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.01 / $158.05 / $210.70
| Facility | | $20.01 | $158.05 | $210.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.51 / $162.56 / $226.91
| Professional | | $17.51 | $162.56 | $226.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.31 / $166.31 / $326.42
| Facility | | $166.31 | $166.31 | $326.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.31 / $196.56 / $218.29
| Professional | | $166.31 | $196.56 | $218.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.13 / $150.05 / $282.63
| Professional | | $132.13 | $150.05 | $282.63 |