- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.50 / $156.47 / $184.09
| Facility | | $121.50 | $156.47 | $184.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.50 / $160.97 / $196.18
| Professional | | $121.50 | $160.97 | $196.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.39 / $110.06 / $145.74
| Professional | | $107.39 | $110.06 | $145.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.41 / $160.78 / $266.85
| Professional | | $115.41 | $160.78 | $266.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.66 / $182.47 / $306.85
| Professional | | $135.66 | $182.47 | $306.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.85 / $130.85 / $130.85
| Professional | | $130.85 | $130.85 | $130.85 |