- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.38 / $141.38 / $155.36
| Facility | | $141.38 | $141.38 | $155.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.03 / $147.63 / $191.28
| Professional | | $130.03 | $147.63 | $191.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.63 / $203.32 / $309.20
| Professional | | $152.63 | $203.32 | $309.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.56 / $160.49 / $227.66
| Facility | | $136.56 | $160.49 | $227.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.36 / $201.97 / $307.61
| Professional | | $155.36 | $201.97 | $307.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.00 / $262.06 / $518.83
| Professional | | $206.00 | $262.06 | $518.83 |