- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.58 / $104.87 / $1,145.43
| Facility | | $61.58 | $104.87 | $1,145.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $61.57 / $136.44
| Professional | | $50.00 | $61.57 | $136.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.48 / $82.92 / $124.71
| Professional | | $70.48 | $82.92 | $124.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.50 / $79.08 / $124.98
| Professional | | $64.50 | $79.08 | $124.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.03 / $65.33 / $110.84
| Facility | | $61.03 | $65.33 | $110.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.56 / $80.43 / $122.03
| Professional | | $66.56 | $80.43 | $122.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.45 / $97.98 / $155.03
| Professional | | $68.45 | $97.98 | $155.03 |