- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.91 / $158.62 / $202.25
| Facility | | $132.91 | $158.62 | $202.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.79 / $134.83 / $158.69
| Professional | | $112.79 | $134.83 | $158.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.35 / $225.13 / $348.56
| Facility | | $144.35 | $225.13 | $348.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.13 / $151.13 / $151.13
| Professional | | $151.13 | $151.13 | $151.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Facility | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Professional | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.83 / $152.65 / $566.78
| Facility | | $134.83 | $152.65 | $566.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.43 / $158.62 / $160.16
| Professional | | $132.43 | $158.62 | $160.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.43 / $156.27 / $160.16
| Professional | | $132.43 | $156.27 | $160.16 |