- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.11 / $158.86 / $180.55
| Professional | | $101.11 | $158.86 | $180.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.61 / $125.61 / $125.61
| Facility | | $125.61 | $125.61 | $125.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.70 / $91.70 / $223.53
| Professional | | $91.70 | $91.70 | $223.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.75 / $174.37 / $212.89
| Facility | | $64.75 | $174.37 | $212.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.57 / $195.88 / $206.19
| Professional | | $185.57 | $195.88 | $206.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $152.16 / $181.22
| Professional | | $30.00 | $152.16 | $181.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.55 / $201.36 / $302.04
| Facility | | $180.55 | $201.36 | $302.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.33 / $149.02 / $216.50
| Professional | | $144.33 | $149.02 | $216.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.72 / $100.29 / $154.54
| Professional | | $92.72 | $100.29 | $154.54 |