- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.62 / $164.16 / $256.33
| Facility | | $143.62 | $164.16 | $256.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.42 / $171.07 / $191.46
| Professional | | $126.42 | $171.07 | $191.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.78 / $160.78 / $295.64
| Facility | | $160.78 | $160.78 | $295.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.49 / $175.42 / $239.29
| Professional | | $150.49 | $175.42 | $239.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.03 / $232.30 / $1,382.00
| Facility | | $147.03 | $232.30 | $1,382.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.51 / $200.26 / $466.85
| Professional | | $157.51 | $200.26 | $466.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.51 / $182.29 / $309.11
| Professional | | $157.51 | $182.29 | $309.11 |