- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.56 / $157.28 / $212.96
| Facility | | $111.56 | $157.28 | $212.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.07 / $141.91 / $185.28
| Professional | | $110.07 | $141.91 | $185.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.79 / $107.79 / $107.79
| Professional | | $107.79 | $107.79 | $107.79 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $157.25 / $157.25 / $157.25
| Professional | 25 | $157.25 | $157.25 | $157.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.94 / $167.40 / $225.21
| Facility | | $137.94 | $167.40 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.40 / $120.19 / $164.65
| Professional | | $82.40 | $120.19 | $164.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.55 / $175.85 / $543.22
| Professional | | $92.55 | $175.85 | $543.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.23 / $166.50 / $228.32
| Professional | | $118.23 | $166.50 | $228.32 |