- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.54 / $98.08 / $115.39
| Facility | | $86.54 | $98.08 | $115.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.56 / $124.00 / $263.74
| Professional | | $92.56 | $124.00 | $263.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.00 / $108.39 / $277.17
| Professional | | $81.00 | $108.39 | $277.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.08 / $140.37 / $196.16
| Facility | | $98.08 | $140.37 | $196.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $214.38 / $699.89
| Professional | | $113.40 | $214.38 | $699.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $194.09 / $287.32
| Professional | | $113.40 | $194.09 | $287.32 |