- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.77 / $102.85 / $108.48
| Professional | | $75.77 | $102.85 | $108.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.18 / $331.16 / $392.05
| Facility | | $245.18 | $331.16 | $392.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.45 / $91.13 / $152.41
| Professional | | $77.45 | $91.13 | $152.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.31 / $144.01 / $144.01
| Facility | | $100.31 | $144.01 | $144.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.13 / $144.00 / $144.01
| Professional | | $105.13 | $144.00 | $144.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.31 / $97.51 / $144.19
| Professional | | $73.31 | $97.51 | $144.19 |