- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.52 / $141.52 / $149.11
| Facility | | $141.52 | $141.52 | $149.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.78 / $147.56 / $183.71
| Professional | | $135.78 | $147.56 | $183.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.18 / $187.50 / $297.45
| Professional | | $140.18 | $187.50 | $297.45 |
- 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
- $153.87 / $153.87 / $230.81
| Professional | | $153.87 | $153.87 | $230.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.97 / $222.86 / $321.50
| Professional | | $157.97 | $222.86 | $321.50 |