- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.93 / $106.86 / $115.28
| Professional | | $84.93 | $106.86 | $115.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.83 / $371.18 / $439.43
| Facility | | $274.83 | $371.18 | $439.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.03 / $109.45 / $175.77
| Professional | | $93.03 | $109.45 | $175.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.30 / $120.62 / $120.62
| Facility | | $114.30 | $120.62 | $120.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.05 / $120.62 / $120.62
| Professional | | $88.05 | $120.62 | $120.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.91 / $118.35 / $161.62
| Professional | | $86.91 | $118.35 | $161.62 |