- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.56 / $140.50 / $186.26
| Facility | | $126.56 | $140.50 | $186.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.74 / $133.46 / $161.50
| Professional | | $82.74 | $133.46 | $161.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.47 / $142.81 / $479.42
| Facility | | $133.47 | $142.81 | $479.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.80 / $140.50 / $140.50
| Professional | | $134.80 | $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
- $126.45 / $144.81 / $526.88
| Facility | | $126.45 | $144.81 | $526.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $140.50 / $141.60
| Professional | | $117.08 | $140.50 | $141.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.08 / $138.15 / $141.66
| Professional | | $117.08 | $138.15 | $141.66 |