- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.36 / $151.94 / $161.27
| Facility | | $148.36 | $151.94 | $161.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.35 / $42.71 / $54.98
| Professional | | $40.35 | $42.71 | $54.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.67 / $227.46 / $373.31
| Facility | | $164.67 | $227.46 | $373.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.09 / $54.82 / $76.94
| Professional | | $39.09 | $54.82 | $76.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.31 / $61.85 / $93.55
| Professional | | $43.31 | $61.85 | $93.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.46 / $59.52 / $107.37
| Professional | | $49.46 | $59.52 | $107.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.36 / $151.94 / $161.27
| Facility | | $148.36 | $151.94 | $161.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.53 / $44.39 / $71.43
| Professional | | $41.53 | $44.39 | $71.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.79 / $60.21 / $100.28
| Professional | | $39.79 | $60.21 | $100.28 |