- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.61 / $119.61 / $266.56
| Facility | | $119.61 | $119.61 | $266.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.60 / $119.61 / $119.61
| Professional | | $119.60 | $119.61 | $119.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.67 / $106.67 / $106.67
| Professional | | $106.67 | $106.67 | $106.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.35 / $131.35 / $131.35
| Facility | | $131.35 | $131.35 | $131.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.35 / $131.35 / $131.35
| Professional | | $131.35 | $131.35 | $131.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.34 / $47.23 / $140.74
| Professional | | $45.34 | $47.23 | $140.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.04 / $140.72 / $182.17
| Facility | | $36.04 | $140.72 | $182.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.69 / $133.68 / $172.63
| Facility | | $125.69 | $133.68 | $172.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.69 / $133.68 / $172.63
| Professional | | $125.69 | $133.68 | $172.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.28 / $140.74 / $147.78
| Professional | | $117.28 | $140.74 | $147.78 |