- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.02 / $155.38 / $166.20
| Facility | | $149.02 | $155.38 | $166.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $155.38 / $155.49
| Professional | | $129.47 | $155.38 | $155.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.58 / $140.58 / $140.58
| Facility | | $140.58 | $140.58 | $140.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.38 / $140.58 / $140.58
| Professional | | $134.38 | $140.58 | $140.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.15 / $129.47 / $129.47
| Facility | | $122.15 | $129.47 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.47 / $129.47 / $129.47
| Professional | | $129.47 | $129.47 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.10 / $129.47 / $129.47
| Professional | | $125.10 | $129.47 | $129.47 |