- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.68 / $126.02 / $364.30
| Facility | | $101.68 | $126.02 | $364.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $95.11 / $128.26
| Professional | | $75.42 | $95.11 | $128.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.24 / $158.44 / $796.21
| Facility | | $116.24 | $158.44 | $796.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.83 / $119.72 / $209.73
| Professional | | $84.83 | $119.72 | $209.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.64 / $110.00 / $176.53
| Professional | | $105.64 | $110.00 | $176.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.24 / $102.64 / $214.10
| Professional | | $87.24 | $102.64 | $214.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.48 / $94.55 / $174.36
| Professional | | $60.48 | $94.55 | $174.36 |