- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.13 / $62.02 / $81.61
| Professional | | $60.13 | $62.02 | $81.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.58 / $262.81 / $311.14
| Facility | | $194.58 | $262.81 | $311.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.31 / $72.31 / $120.96
| Professional | | $72.31 | $72.31 | $120.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.52 / $64.52 / $79.59
| Facility | | $64.52 | $64.52 | $79.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.10 / $64.52 / $64.52
| Professional | | $47.10 | $64.52 | $64.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $68.66 / $114.43
| Professional | | $46.77 | $68.66 | $114.43 |