- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.07 / $150.50 / $362.05
| Facility | | $106.07 | $150.50 | $362.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.37 / $68.27 / $173.00
| Professional | | $23.37 | $68.27 | $173.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.27 / $137.59 / $285.08
| Facility | | $86.27 | $137.59 | $285.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.55 / $63.32 / $146.84
| Professional | | $22.55 | $63.32 | $146.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.18 / $52.44 / $90.52
| Facility | | $17.18 | $52.44 | $90.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.35 / $198.55 / $198.55
| Professional | | $93.35 | $198.55 | $198.55 |