- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.82 / $168.96 / $170.84
| Facility | | $158.82 | $168.96 | $170.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.46 / $133.47 / $161.50
| Professional | | $133.46 | $133.47 | $161.50 |
- 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
- $20.56 / $133.47 / $190.86
| Facility | | $20.56 | $133.47 | $190.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.19 / $146.82 / $166.84
| Professional | | $34.19 | $146.82 | $166.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.98 / $200.22 / $293.74
| Facility | | $123.98 | $200.22 | $293.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.55 / $154.55 / $158.06
| Professional | | $154.55 | $154.55 | $158.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.30 / $140.50 / $140.50
| Professional | | $132.30 | $140.50 | $140.50 |