- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.07 / $157.94 / $457.60
| Facility | | $95.07 | $157.94 | $457.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.46 / $146.81 / $224.25
| Professional | | $133.46 | $146.81 | $224.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.82 / $234.35 / $427.10
| Facility | | $146.82 | $234.35 | $427.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.50 / $140.50 / $140.50
| Professional | | $140.50 | $140.50 | $140.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Facility | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.13 / $131.13 / $131.13
| Professional | | $131.13 | $131.13 | $131.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.98 / $133.47 / $190.86
| Facility | | $73.98 | $133.47 | $190.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.10 / $146.82 / $218.89
| Professional | | $100.10 | $146.82 | $218.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $140.50 / $140.50
| Professional | | $117.08 | $140.50 | $140.50 |