- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.49 / $101.49 / $116.71
| Facility | | $101.49 | $101.49 | $116.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.49 / $113.23 / $128.66
| Professional | | $101.49 | $113.23 | $128.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.11 / $102.94 / $102.94
| Facility | | $97.11 | $102.94 | $102.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Professional | | $102.94 | $102.94 | $102.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.23 / $136.38 / $184.00
| Facility | | $113.23 | $136.38 | $184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $113.23 / $128.68
| Professional | | $102.94 | $113.23 | $128.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.00 / $78.00 / $110.68
| Professional | | $78.00 | $78.00 | $110.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.55 / $204.40 / $329.80
| Facility | | $166.55 | $204.40 | $329.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.52 / $123.52 / $128.68
| Professional | | $123.52 | $123.52 | $128.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.94 / $102.94 / $102.94
| Professional | | $102.94 | $102.94 | $102.94 |