- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.93 / $132.93 / $134.46
| Professional | | $97.93 | $132.93 | $134.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.89 / $427.97 / $506.66
| Facility | | $316.89 | $427.97 | $506.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.78 / $117.78 / $196.97
| Professional | | $117.78 | $117.78 | $196.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.63 / $159.22 / $159.22
| Facility | | $129.63 | $159.22 | $159.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.23 / $159.22 / $159.22
| Professional | | $116.23 | $159.22 | $159.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.25 / $140.18 / $186.35
| Professional | | $105.25 | $140.18 | $186.35 |