- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.10 / $109.77 / $117.76
| Facility | | $105.10 | $109.77 | $117.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.02 / $134.07 / $173.00
| Professional | | $116.02 | $134.07 | $173.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.73 / $174.34 / $247.09
| Professional | | $125.73 | $174.34 | $247.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.92 / $214.92 / $214.92
| Facility | | $214.92 | $214.92 | $214.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.62 / $179.50 / $320.23
| Professional | | $114.62 | $179.50 | $320.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.65 / $1,029.38 / $1,575.08
| Facility | | $526.65 | $1,029.38 | $1,575.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.54 / $105.02 / $173.17
| Professional | | $63.54 | $105.02 | $173.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.72 / $151.22 / $238.17
| Professional | | $110.72 | $151.22 | $238.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.94 / $147.88 / $260.41
| Professional | | $104.94 | $147.88 | $260.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.36 / $103.15 / $103.15
| Professional | | $101.36 | $103.15 | $103.15 |