- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.86 / $105.44 / $135.35
| Facility | | $103.86 | $105.44 | $135.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.03 / $93.16 / $335.00
| Professional | | $81.03 | $93.16 | $335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $109.28 / $169.38
| Professional | | $100.00 | $109.28 | $169.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.25 / $136.83 / $200.98
| Professional | | $75.25 | $136.83 | $200.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.09 / $108.75 / $183.22
| Professional | | $86.09 | $108.75 | $183.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $208.07
| Professional | | $83.18 | $120.23 | $208.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.34 / $96.09 / $131.02
| Professional | | $93.34 | $96.09 | $131.02 |