- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.62 / $161.62 / $164.84
| Facility | | $161.62 | $161.62 | $164.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $161.62 / $177.79
| Professional | | $161.62 | $161.62 | $177.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.53 / $182.98 / $182.98
| Facility | | $155.53 | $182.98 | $182.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.83 / $182.97 / $186.61
| Professional | | $173.83 | $182.97 | $186.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.62 / $161.62 / $161.62
| Facility | | $161.62 | $161.62 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.62 / $202.70 / $260.14
| Professional | | $161.62 | $202.70 | $260.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.84 / $263.74 / $329.68
| Facility | | $164.84 | $263.74 | $329.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.84 / $164.84 / $446.65
| Professional | | $164.84 | $164.84 | $446.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.86 / $202.70 / $331.40
| Facility | | $195.86 | $202.70 | $331.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.86 / $202.70 / $260.14
| Professional | | $195.86 | $202.70 | $260.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.54 / $161.62 / $242.43
| Professional | | $153.54 | $161.62 | $242.43 |