- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.56 / $156.38 / $477.28
| Facility | | $126.56 | $156.38 | $477.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.46 / $133.47 / $168.17
| Professional | | $133.46 | $133.47 | $168.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.12 / $167.20 / $227.64
| Facility | | $142.12 | $167.20 | $227.64 |
- 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
- $123.64 / $140.50 / $164.17
| Facility | | $123.64 | $140.50 | $164.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.04 / $138.15 / $140.50
| Professional | | $125.04 | $138.15 | $140.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.04 / $138.15 / $140.50
| Professional | | $125.04 | $138.15 | $140.50 |