- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.66 / $139.66 / $620.40
| Facility | | $139.66 | $139.66 | $620.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.60 / $144.44 / $198.25
| Professional | | $141.60 | $144.44 | $198.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.19 / $145.52 / $153.18
| Facility | | $130.19 | $145.52 | $153.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.41 / $146.41 / $146.41
| Professional | | $146.41 | $146.41 | $146.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.59 / $133.59 / $141.60
| Facility | | $133.59 | $133.59 | $141.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.60 / $141.60 / $141.60
| Professional | | $141.60 | $141.60 | $141.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.52 / $141.00 / $197.39
| Facility | | $110.52 | $141.00 | $197.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.56 / $141.00 / $155.61
| Professional | | $136.56 | $141.00 | $155.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.60 / $141.60 / $171.93
| Professional | | $141.60 | $141.60 | $171.93 |