- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.62 / $163.24 / $166.47
| Facility | | $161.62 | $163.24 | $166.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $163.24 / $177.79
| Professional | | $161.62 | $163.24 | $177.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.81 / $185.81 / $278.72
| Facility | | $185.81 | $185.81 | $278.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.81 / $185.81 / $189.53
| Professional | | $185.81 | $185.81 | $189.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.37 / $121.37 / $121.37
| Facility | | $121.37 | $121.37 | $121.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.47 / $152.47 / $161.62
| Facility | | $152.47 | $152.47 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $161.62 / $161.62
| Professional | | $161.62 | $161.62 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.56 / $161.62 / $217.51
| Professional | | $153.56 | $161.62 | $217.51 |