- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.72 / $117.40 / $117.40
| Facility | | $114.72 | $117.40 | $117.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.92 / $104.73 / $118.44
| Professional | | $62.92 | $104.73 | $118.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.23 / $12.37 / $18.01
| Professional | | $7.23 | $12.37 | $18.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.53 / $11.53 / $11.53
| Facility | | $11.53 | $11.53 | $11.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.02 / $280.02 / $280.02
| Professional | | $280.02 | $280.02 | $280.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $10.36 / $13.69
| Professional | | $7.48 | $10.36 | $13.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.92 / $110.84 / $146.80
| Facility | | $62.92 | $110.84 | $146.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $145.00 / $186.00
| Professional | | $14.00 | $145.00 | $186.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.73 / $152.38 / $247.71
| Facility | | $106.73 | $152.38 | $247.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.73 / $152.38 / $247.71
| Professional | | $106.73 | $152.38 | $247.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.62 / $145.91 / $231.16
| Professional | | $83.62 | $145.91 | $231.16 |