- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.12 / $265.73 / $286.35
| Facility | | $119.12 | $265.73 | $286.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $119.12 / $167.44
| Professional | | $114.54 | $119.12 | $167.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.84 / $139.13 / $362.98
| Facility | | $110.84 | $139.13 | $362.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $114.54 / $114.54
| Professional | | $114.54 | $114.54 | $114.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.54 / $114.54 / $114.54
| Facility | | $114.54 | $114.54 | $114.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $114.54 / $114.54
| Professional | | $114.54 | $114.54 | $114.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $114.54 / $138.71
| Professional | | $114.54 | $114.54 | $138.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.73 / $265.73 / $370.50
| Facility | | $265.73 | $265.73 | $370.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.68 / $119.12 / $215.23
| Professional | | $115.68 | $119.12 | $215.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.54 / $114.54 / $200.45
| Professional | | $114.54 | $114.54 | $200.45 |