- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.41 / $90.30 / $93.11
| Facility | | $89.41 | $90.30 | $93.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.41 / $89.41 / $93.88
| Professional | | $89.41 | $89.41 | $93.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.75 / $108.04 / $182.80
| Facility | | $90.75 | $108.04 | $182.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.41 / $89.41 / $126.96
| Professional | | $89.41 | $89.41 | $126.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.88 / $89.41 / $89.41
| Facility | | $86.88 | $89.41 | $89.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.41 / $89.41 / $97.00
| Professional | | $89.41 | $89.41 | $97.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.41 / $89.41 / $107.29
| Professional | | $89.41 | $89.41 | $107.29 |