- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.83 / $109.74 / $129.11
| Facility | | $96.83 | $109.74 | $129.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.53 / $106.30 / $144.60
| Professional | | $83.53 | $106.30 | $144.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.35 / $134.26 / $204.80
| Professional | | $82.35 | $134.26 | $204.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.87 / $114.49 / $138.28
| Professional | | $95.87 | $114.49 | $138.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.00 / $138.97 / $181.41
| Professional | | $111.00 | $138.97 | $181.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.44 / $127.32 / $179.28
| Professional | | $97.44 | $127.32 | $179.28 |