- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.16 / $1,161.81 / $1,161.81
| Facility | | $151.16 | $1,161.81 | $1,161.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $167.94
| Professional | | $151.16 | $151.16 | $167.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.46 / $153.46 / $153.46
| Facility | | $153.46 | $153.46 | $153.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.46 / $153.46 / $153.46
| Professional | | $153.46 | $153.46 | $153.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.61 / $142.61 / $213.29
| Facility | | $142.61 | $142.61 | $213.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Professional | | $151.16 | $151.16 | $151.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.33 / $160.22 / $269.19
| Facility | | $150.33 | $160.22 | $269.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.77 / $166.28 / $214.65
| Professional | | $164.77 | $166.28 | $214.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $151.16
| Professional | | $151.16 | $151.16 | $151.16 |