- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.57 / $142.27 / $167.37
| Facility | | $109.57 | $142.27 | $167.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.84 / $153.00 / $206.26
| Professional | | $123.84 | $153.00 | $206.26 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $172.37 / $172.37 / $172.37
| Professional | 25 | $172.37 | $172.37 | $172.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.97 / $167.37 / $220.00
| Professional | | $137.97 | $167.37 | $220.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.42 / $116.42 / $142.61
| Facility | | $116.42 | $116.42 | $142.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.88 / $187.42 / $234.28
| Professional | | $135.88 | $187.42 | $234.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.49 / $280.49 / $280.49
| Facility | | $280.49 | $280.49 | $280.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.00 / $174.83 / $324.58
| Professional | | $80.00 | $174.83 | $324.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.09 / $175.75 / $277.57
| Facility | | $146.09 | $175.75 | $277.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.10 / $185.12 / $1,234.10
| Professional | | $124.10 | $185.12 | $1,234.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.45 / $160.56 / $300.00
| Professional | | $120.45 | $160.56 | $300.00 |