- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.37 / $101.37 / $135.05
| Facility | | $101.37 | $101.37 | $135.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $105.06 / $160.35
| Professional | | $100.01 | $105.06 | $160.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.64 / $203.32 / $893.84
| Facility | | $193.64 | $203.32 | $893.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.61 / $113.80 / $156.74
| Professional | | $76.61 | $113.80 | $156.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.63 / $129.63 / $129.63
| Facility | | $129.63 | $129.63 | $129.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.64 / $94.64 / $129.63
| Professional | | $94.64 | $94.64 | $129.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.91 / $156.74 / $906.14
| Facility | | $92.91 | $156.74 | $906.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.84 / $96.61 / $235.37
| Professional | | $71.84 | $96.61 | $235.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.27 / $96.61 / $194.59
| Professional | | $72.27 | $96.61 | $194.59 |